A Nordin

The Queen Elizabeth Hospital, Tarndarnya, South Australia, Australia

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Publications (13)29.67 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: To determine the potential benefits of ISC (intermittent self-catheterisation) over SPC (supra-pubic catheterisation) in the post-operative bladder care of women following radical hysterectomy. A prospective randomised controlled trial of women treated by radical hysterectomy for early stage cervical cancer. RESULTS.: 40 women were recruited to the study, 21 to ISC and 19 to SPC. All patients randomised to ISC were able to learn the technique of ISC satisfactorily following a period of pre-operative training. The day 3 and day 5 positive CSU (catheter specimen of urine) rate was significantly higher in the ISC group (42% and 63%) compared to the SPC group (6% and 18%), P = 0.05 and P = 0.004, respectively). Eight of 17 patients randomised to SPC (47%) documented having symptoms/problems arising from the SPC site of which 4 (23%) were shown to have a positive wound swab. There was no significant difference in length of period for bladder care between the two groups, P = 0.83. However, there were significant differences in patient acceptability (P = 0.009), freedom to lead a normal life (P = 0.000), disturbance at night (P = 0.006) and patient anxiety/embarrassment (P = 0.005) between the two groups. Patients are able to learn the technique of ISC without difficulty. Despite a greater urinary tract infection rate, the high incidence of SPC site problems can be avoided by use of ISC. The technique of ISC was seen to be more acceptable to patients allowing fewer disturbances at night, greater freedom to lead a normal life during the day and less anxiety/embarrassment compared to SPC.
    Gynecologic Oncology 12/2005; 99(2):437-42. · 3.93 Impact Factor
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    ABSTRACT: To assess the feasibility of a one-stop colposcopy clinic for the management of women with low-grade smear abnormalities. Secondly, to determine whether the approach of immediate information of biopsy results combined with treatment if indicated helps to reduce patient anxiety and improve overall patient satisfaction with the colposcopy process. Prospective study following the introduction of a "one-stop" process for the management of women with low grade smear abnormalities. First 118 women managed in a "one-stop" clinic during an 8-month period. Assessment of patient anxiety via self-completed questionnaires and comparison of anxiety scores with a control group managed via a standard clinic. The median waiting time for results in the one-stop clinic was 120 min (range: 100-165). All women in both groups felt anxious at the time of the clinic visit. However, after 1 week the majority of patients managed via the one-stop process felt slight anxiety only (P=0.0001) as opposed to those patients in the control group who remained anxious (P=NS). In addition, all women said they would prefer the one-stop approach for further smear abnormalities if a further colposcopic examination was warranted. A one-stop colposcopy clinic is feasible for the management of women with low-grade smear abnormalities. In addition, it delivers a quality service, optimises patient management, reduces anxiety and is the patient's choice.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 11/2001; 98(2):205-8. · 1.84 Impact Factor
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    ABSTRACT: The aim of this study was to define the role of surgery in managing patients with a primary squamous vaginal cancer. A retrospective review was conducted of patients with primary invasive vaginal cancer managed at one institution over a 25-year period. The results were compared with those of all major publications of the past 20 years. A total of 84 patients were reviewed. Forty-five (66%) were of squamous origin. The median follow-up was 45 months (range: 0.6-268). The patients were primarily treated by surgery in 67% and by radiotherapy alone in 33% of cases. The 5- and 10-year overall survival was, respectively, 74 and 58%. For stage I the figures were 91 and 70%. These survival rates compared favorably with those of published series of cases managed by radiotherapy alone. Univariate analysis showed that age (P = 0.004), size (P = 0.009), site (P = 0.016), lymph node status (P = 0.022), FIGO stage (P = 0.027), and treatment (P = 0.003) were relevant prognostic factors. Multiple regression analysis, however, revealed that only age (P = 0.009) and size (P = 0.037) were independent prognostic variables. Stage I and II squamous vaginal cancer patients have good outcomes in terms of survival and local tumor control if they are managed by initial surgery followed by selective radiotherapy.
    Gynecologic Oncology 07/2001; 81(3):360-5. · 3.93 Impact Factor
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    ABSTRACT: The aim of this study was to address the hypothesis of no difference between elderly and younger patients' desire for optimal surgery and disease cure. The new ARGOSE questionnaire with established instruments was administered to 189 gynecologic cancer patients (95 aged <65, 57 aged 65-74, and 37 aged 75+ years). Disease diagnosis differed between the <65 years and 65+ years cohorts (P < 0.001), but treatment modalities were similar (P = 0.28). Influences of family and friends and past experiences of cancer had little influence on treatment decisions. There was no difference between cohorts in desire for surgery offering a chance of disease cure (P = 0.75), except that the elderly desire cure more if treatment is associated with disfigurement than do the young. (P = 0.029). The elderly believe more strongly than the young that the elderly value cure (P < 0.001). Issues of sexuality and femininity associated with gynecologic cancer and treatment are more important to younger patients (P < 0.001). The elderly support equality of care with relation to age more strongly than the young. However, in a situation of resource limitation, inequality favoring the young is opposed less strongly by the elderly than by the young. Social desirability bias may have influenced this finding. All cohorts reported symptom palliation to be of secondary importance to treatments offering a possibility of cure (P = 0.26). The elderly believe more strongly that doctors should make management decisions (P < 0.001). The elderly desire radical surgery and disease cure as strongly as the young. They are less likely to question their doctors' decisions and are therefore vulnerable to physicians' age bias. There is no justification for rationing care on the basis of chronological age.
    Gynecologic Oncology 06/2001; 81(3):447-55. · 3.93 Impact Factor
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    ABSTRACT: Inguinal metastasis is a hitherto unreported presenting feature of fallopian tube adenocarcinoma. We describe a case of a 69-year-old patient whose first manifestation of fallopian tube adenocarcinoma was an enlarged inguinal lymph node. This was excised and confirmed to be metastatic adenocarcinoma. She was investigated by diagnostic laparoscopy and subsequently underwent laparotomy with total abdominal hysterectomy, omentectomy, and pelvic and para-aortic lymph node dissection. All but two of the lymph nodes extirpated were negative. Fallopian tube adenocarcinoma may rarely present with metastatic inguinal lymphadenopathy.
    Gynecologic Oncology 06/2001; 81(2):324-5. · 3.93 Impact Factor
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    ABSTRACT: 1) to determine the prevalence of urinary incontinence before and after radical surgical treatment for early cervical cancer, 2) to retrospectively analyse the outcome results following the investigation/treatment of incontinence in these women. 27 women were studied prospectively by questionnaire prior to surgery and six weeks and three months after surgery (group 1). Seventy-seven women who were more than 12 months post-radical surgery were questioned directly at the follow-up clinic (group 2). Three hundred and two satisfactory responses were obtained to questionnaires sent to general practitioners of patients previously treated by radical surgery for early cervical cancer (group 3). 14.8% of women reported regular incontinence prior to surgery, and 48.1% and 29.6% of women, respectively, reported regular incontinence six weeks and three months after surgery; 31.2% of women also reported regular incontinence more than 12 months after post-radical surgery. Of the women in the 12-month post-radical surgery group, 16.6% had considered their symptoms of regular incontinence severe enough to attend their local practice for treatment and 14.6% (44 women) were referred for further management. In six of these 44 patients (13.6%), spontaneous resolution of incontinence occurred at varying intervals within the first 12 months following radical surgery. Twenty-four of the 44 women who were referred underwent urodynamic investigation. Of these 24 women, in 17 cases the diagnosis was genuine stress incontinence (GSI), of which, in seven cases (41%) GSI was the sole urodynamic abnormality. In six of these seven cases (85.7%), the women were cured or very greatly improved following treatment with either physiotherapy or surgery. However, only six of the remaining ten cases (60%) with coexistent abnormalities achieved this result. Patients with coexistent impaired bladder compliance showed the poorest result, as only two of the six cases (33%) achieved satisfactory improvement following treatment. Non-fistulous urinary incontinence following radical pelvic surgery for carcinoma of the cervix despite being a common problem shows a significant spontaneous improvement rate within the first 12 months following surgery. Urodynamics should be a mandatory investigation in patients who complain of persisting problems thereafter. Subjective improvement rates for women with genuine stress incontinence alone are in excess of 85%, being comparable to those of women without any prior history of radical pelvic surgery.
    European journal of gynaecological oncology 02/2001; 22(1):26-30. · 0.58 Impact Factor
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    ABSTRACT: Vaginal melanoma is a rare and highly malignant disease. This report describes the characteristics and clinical course of all patients treated at one institute (Northern Gynaecological Oncology Centre, UK) over the last 25 years. Of a total of nine patients identified with a primary malignant vaginal melanoma, only one patient survived for more than five years. A literature review revealed only 21 reported cases with a survival greater than five years. The most important factor for survival appears to be the tumour size. Treatment modality varied equally within the group of long-term survivors (27% radical surgery, 27% wide local excision, 27% radiotherapy, 14% wide local excision and radiotherapy, and 5% unknown therapy). The prognosis of patients with primary malignant melanoma is poor, regardless of primary therapy (conservative or radical). Conservative treatment and accurate investigation of every discoloured lesion is recommended.
    European journal of gynaecological oncology 02/2001; 22(1):20-2. · 0.58 Impact Factor
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    ABSTRACT: A retrospective review was performed of 138 cases of squamous vulval cancer referred to Gateshead between 1986 and 1997, with a median follow-up of 48 months. Eighteen recurrences were detected, 11 within one year of surgery. All nine patients with groin/distant recurrence (including 4 presenting initially with local recurrence only) died of vulval cancer. Vulval pain, bleeding or other symptoms heralded all recurrences. Routine review was ineffective in detecting recurrence. Eight cases were detected by general practitioners, three by specialists, and one was self-diagnosed. Six of these had had clinical review less than two months previously. Follow-up does not appear to offer early detection or survival advantages. Patient education, with symptom-triggered rapid clinic access, may be more effective. Prospective research is indicated to assess both the effectiveness and psychological implications of routine follow-up and alternative strategies.
    European journal of gynaecological oncology 02/2001; 22(1):36-9. · 0.58 Impact Factor
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    ABSTRACT: The aim of this study was to determine whether site and size of tumor masses prior to complete surgical cytoreduction affect outcome survival. A retrospective review was performed of 53 women with stage II and III epithelial ovarian cancer following complete surgical cytoreduction. Fifteen cases (28%) were classified as stage II and the remaining 38 cases (72%) as stage III. The overall median survival was 58 months with overall 2- and 5-year survivals of 76 and 42%, respectively. On univariate analysis, women with well differentiated tumors did significantly better than those with moderately or poorly differentiated tumours (P = 0.0009). FIGO stage did not reach statistical significance (P = 0.066). On multivariate analysis, comparing patient's age, previous history of pelvic surgery, previous history of malignancy, performance of lymphadenectomy for visibly/palpably enlarged nodes, performance of bowel resection, presence of concomitant tumors, positive pelvic and/or para-aortic lymph nodes, histological type, histological grade, and FIGO stage, only histological grade remained an independent variable affecting outcome survival (P = 0.0004; FIGO stage, P = 0.22) (hazard ratio = 6.5: well versus poor differentiation, 95% confidence interval, 1.7-25.5). When surgical cytoreduction to no visible disease has been achieved in women with stage II and III epithelial ovarian cancer, FIGO stage, i.e., site and size of tumor masses prior to surgical cytoreduction, does not appear to influence outcome survival. The aggressiveness of the remaining microscopic disease would seem to be determined largely by histological grade. Bearing in mind the retrospective nature of this study and the relatively small cohort of patients, the results would appear to suggest that it is unlikely that there are any other significant parameters (hidden factors) affecting tumor biology which are independent of tumor grade in these patients. A possible implication of this result is that complete surgical cytoreduction confers a survival benefit by producing a biologically more homogeneous tumor.
    Gynecologic Oncology 09/2000; 78(2):176-80. · 3.93 Impact Factor
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    ABSTRACT: The aim of this study was to determine the value of optimal cytoreduction in stage IV epithelial ovarian cancer. A retrospective review was performed of 37 women with stage IV epithelial ovarian cancer treated by radical surgery. Optimal surgery to less than 2 cm tumor deposits was performed in 16 of the 37 cases (43%) and tumor debulking to less than 1 cm tumor deposits in 6 cases (16.2%). Twenty-three cases (62%) were designated stage IV because of the presence of liver metastases alone. Although no patients died within 2 weeks of surgery, 7 of the 37 cases (22%) failed to survive more than 50 days after primary surgery. The overall median survival was 11 months with overall 2- and 5-year survivals of 23 and 9%, respectively. On multivariate analysis comparing age, histological type, tumor grade, place of surgery, secondary surgical procedure, performance of bowel surgery, presence of liver metastases, and optimal cytoreduction, only optimal surgery and residual tumor deposits of less than 2 cm, or less than 1 cm, remained highly significant (P = 0.0029 and 0.0086, respectively). Even when assessing only the 27 cases who were designated as having stage IV disease because of the presence of liver metastases, by multivariate analysis, only optimal surgery and residual tumor deposits of less than 2 cm, or less than 1 cm, remained significant (P = 0.023 and 0.036, respectively). Site of metastases designating stage IV status was not associated with a reduced likelihood of achieving optimal debulking (P = 0.18). Optimal cytoreduction in women with stage IV epithelial ovarian cancer with or without hepatic metastases is associated with a more favorable outcome survival.
    Gynecologic Oncology 09/2000; 78(2):171-5. · 3.93 Impact Factor
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    ABSTRACT: Does age-related inequality of cancer care reflect patient preference or physician prejudice? We hypothesize no difference between elderly and younger patients' desire for optimal surgery and disease cure, and psychological adaptation to cancer. A newly developed questionnaire to assess attitudes to radical gynecological surgery in the elderly (ARGOSE) and a battery of established instruments were administered to 54 gynecological cancer patients (32 aged 65 + years; and 22 aged < 65 years) by structured interview. Disease diagnosis differed between cohorts (P = 0.007), but treatment modalities were similar (P = 0.46). There was no difference between cohorts in desire for optimal surgery and disease cure. Trends suggest the young consider a patient's age is less important than do the elderly, but the elderly may oppose age-related economic rationing of treatment more than the young. Furthermore, elderly individuals tend to perceive their seniors too elderly for treatment, but not themselves. The elderly believe more strongly that doctors should make management decisions. Perceptions of change in body image after cancer treatment did not differ between cohorts. The influence of age in determining attitudes is complex. A larger study with increased power is indicated to examine trends revealed in this pilot study.
    International Journal of Gynecological Cancer 08/2000; 10(4):323-329. · 1.94 Impact Factor
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    ABSTRACT: To determine whether past history of pelvic surgery is of prognostic significance in stage III epithelial ovarian cancer. A retrospective review of 140 women with stage III epithelial ovarian cancer. Sixteen women had previously undergone pelvic surgery including eight sterilisations (6%), seven hysterectomies (5%) and one ovarian cystectomy (0.7%). Women with a past history of sterilisation were significantly younger (median age, 46 years) than women without a past history of sterilisation (median age, 63 years), and also significantly younger than women with a past history of hysterectomy (median age, 58 years). In addition, the sterilisation procedure was performed at a significantly younger age than the hysterectomy procedure (p=0.008). On multivariate analysis comparing previous pelvic surgery, previous malignancy, place of surgery, interval/secondary debulking, presence of concomitant tumour, performance of bowel surgery, histological grade, histological type, size of residual disease and age, all of the following were seen to be independent variables associated with outcome survival; previous sterilisation (p=0.0012), age (p=0.0074), histological type (p=0.025), histological grade (p=0.0017) and size of residual disease (p=0.0043). Past history of sterilisation appears to be an adverse independent prognostic indicator in women presenting with stage III epithelial ovarian cancer. To have developed ovarian cancer despite the protective effects of a sterilisation procedure against environmental factors might possibly suggest a predisposition to ovarian cancer in these women. Further studies are indicated to confirm the present results.
    European journal of gynaecological oncology 02/2000; 21(4):357-61. · 0.58 Impact Factor
  • 01/2000;

Publication Stats

139 Citations
522 Views
29.67 Total Impact Points

Institutions

  • 2001
    • The Queen Elizabeth Hospital
      Tarndarnya, South Australia, Australia
  • 2000–2001
    • Queen Elizabeth Hospital Birmingham
      Birmingham, England, United Kingdom
    • Teesside University
      Middlesborough, England, United Kingdom