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Biomedical subjects

B Piura

Publications and source records attributed to B Piura.

At least 91 records · Page 5Linked to original sources
PubMed1993

Recurrent squamous cell carcinoma of the vulva: a study of 73 cases.

In a study of 73 patients, diagnosed with recurrent squamous cell carcinoma of the vulva between 1975 and 1990, the effect of clinical variables on the outcome was evaluated. The overall 5-year survival rate was 35.2%. Of the 73 patients, 33 (45.2%) originally had Stage I or II disease and 40 (54.8%) Stage III or IVA; 49 (67.1%) recurred less than 2 years and 24 (32.9%) more than 2 years after initial surgery; and 39 (53.4%) recurred on the vulva only, while 34 (46.6%) recurred beyond the vulva. Of 59 patients who had groin lymph node dissection at initial surgery, 26 (44%) had negative and 33 (56%) had positive nodes. By means of univariate analyses, a significant worsening in outcome was demonstrated with advancing original stage of disease (P < 0.001), positivity of groin lymph nodes (P < 0.01), shortening of recurrence-free interval (P < 0.001), and extension of recurrence beyond the vulva (P < 0.001). In a multivariate analysis (Cox proportional hazards model) recurrence site was the strongest and the only significant predictor of survival. The death risk showed a 3.7-fold increase (95% confidence intervals: 1.6 to 8.7, P = 0.002) for recurrence beyond the vulva over recurrence on the vulva only. For patients who recurred in the vulva only, wide radical local excision provided acceptable survival results, while for all other patients, regardless of type of treatment, the outcome was poor.

Adult↗
PubMed1993

The case for conservative management of "incomplete excision" of CIN after laser conization.

Three hundred thirteen laser cone biopsies were performed for cervical intraepithelial neoplasia (CIN) over a 4-year period. The mean age of the patients was 39.9 years and average cytology follow-up was just under 3 years. Six patients defaulted colposcopic review and were excluded from analysis. Of the 75 cases with CIN extending to the endocervical resection margin, 9 (12%) were found to have residual disease. Only 2 (3.6%) of 56 cases with CIN extending to the ectocervical margin had residual CIN detected. In the 176 cases in which the CIN lesion was excised completely there have been no cases of residual CIN. The overall detection of residual disease was 3.6%. Further surgery in those cases with CIN extending to the resection margin is excessive. These patients should be managed conservatively with regular cytological follow-up.

Adult↗
PubMed1993

Persistence of antichlamydial antibodies after treatment of acute salpingitis with doxycycline.

The effect of treatment with doxycycline on serum IgG and IgA antichlamydial antibodies was evaluated in 33 women who had had acute salpingitis associated with high titers of serum IgG (> or = 1:128) and/or IgA (> or = 1:16) antichlamydial antibodies. Overall, 29 women (87.9%) remained with high titers of IgG and/or IgA antibodies. No change or insignificant change in IgG antibody titer was demonstrated in 21 women (63.6%) and in IgA antibody titer in 21 women (63.6%). Positive seroconversion or a significant increase (> or = 4-fold) in IgG antibody titer was demonstrated in eight women (24.2%) and in IgA antibody titer in six women (18.1%). Negative seroconversion or a significant decrease in IgG antibody titer was demonstrated in four women (12.1%) and in IgA antibody titer in six women (18.1%). It is concluded that in most patients who had acute salpingitis associated with pretreatment high titers of serum antichlamydial antibodies, posttreatment titers may remain high even if treatment with doxycycline results in complete resolution of clinical signs and symptoms of the disease.

Acute Disease↗
PubMed1993

The Wallace technique of ureteroileal anastomosis and its use in gynecologic oncology: a study of 81 cases.

OBJECTIVE: To report the indications for surgery, morbidity, and results of treatment using the Wallace ileal conduit for supravesical urinary diversion. METHODS: Over a 15-year period (1977-1991), 81 patients, all with an underlying gynecologic malignancy requiring urinary diversion, had ileal conduit surgery performed at the Regional Department of Gynecological Oncology, Gateshead, England using the Wallace technique. Patient details stored in a computerized data base were reviewed retrospectively. RESULTS: Thirty-nine patients (48%) had received radiotherapy before conduit surgery. In 70% of cases, urinary diversion was performed as part of an exenterative procedure. Early postoperative complications occurred in 56% of cases and were mainly related to infection. Long-term complications included fistula (three), stoma retraction (three), loss of renal function (three), tumor metastases (two), and stoma herniation (one). There was one postoperative death secondary to septicemia. By 1991, 42 patients (52%) had died of their primary disease. CONCLUSION: We believe that for urinary diversion in the gynecologic oncology patient, the ileal conduit, in particular the Wallace technique, is the procedure of choice.

Adult↗
PubMed1992

Malignant melanoma of the vulva: a clinicopathologic study of 18 cases.

In a study of 18 patients diagnosed with vulvar malignant melanoma between 1975 and 1991, the effect of clinical and pathologic variables on the survival was evaluated. The overall 5-year survival rate was 28.6%. In 14 cases the tumor was retrospectively microstaged with use of Breslow depth and Chung levels. International Federation of Gynecology and Obstetrics (FIGO) stage and Breslow depth did not correlate well with survival. Positivity of groin lymph nodes at initial surgery was associated with an insignificant worsening in survival. An inverse correlation, although statistically not significant, was demonstrated between advancing Chung levels and survival. It is concluded that since the data with respect to microstaging of vulvar malignant melanoma is, as yet, still limited, great caution should be used in electing less aggressive surgery than radical vulvectomy and bilateral groin lymphadenectomy for patients with early-microstage localized disease.

Aged↗
PubMed1991

Antinuclear autoantibodies in healthy nonpregnant and pregnant women and their offspring.

Antinuclear autoantibodies have previously been detected in sera of healthy women although less frequently than in sera of women with autoimmune disorders. The effect of pregnancy on antinuclear autoantibody production in healthy women is as yet debatable. We present four studies in which, by employing the ELISA method, we evaluated the presence of six antinuclear autoantibodies (anti-ds DNA, anti-ss DNA, anti-poly(I), anti-cardiolipin, anti-Sm, and anti-RNP) in the sera of more than 1,000 healthy pregnant and nonpregnant women, including 196 pairs of matched maternal and cord blood sera. In all four studies healthy pregnant women did not demonstrate significantly higher prevalence rates of various serum antinuclear autoantibodies as compared to healthy non-pregnant women. All detected autoantibodies were of the IgM isotype. In only one infant (born to a healthy seronegative mother) was an autoantibody (IgM anti-ss DNA) detected. This may indicate that in certain circumstances the fetus is capable of self-production of autoantibodies.

Adolescent↗
PubMed1990

Experience in the treatment of epithelial ovarian carcinoma with cisplatinum-containing combination chemotherapy and dose intensity calculation.

Twenty-six patients with epithelial ovarian carcinoma, were treated by cisplatinum--containing combination chemotherapy following initial laparotomy. The mean number of treatment cycles was 7.8 (median: 9). The mean dose intensity (DI) and mean relative dose intensity (RDI) respectively were for cyclophosphamide: 108 mg/m2/week and 0.65, for doxorubicin: 8.6 mg/m2/week and 0.51, and for cisplatinum: 9.8 mg/m2 week and 0.59. The mean average relative dose intensity (ARDI) was 0.53. The three-year survival for all patients was 43%. No statistically significant difference in the three-year survival between patients receiving RDI's and ARDI of less than median dose and those receiving RDI's and ARDI of more than median dose could be demonstrated. Larger series are needed to test whether, and to what extent, dose intensity contributes to outcome, independently of the total amount of drug given.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Optimal debulking following chemotherapy of advanced-stage epithelial ovarian carcinoma.

We reviewed the records of 110 consecutive patients with advanced-stage epithelial ovarian carcinoma treated at the Soroka Medical Center, Beer-Sheva, Israel, from 1961-1987. Twenty patients (18.1%) had optimal debulking at initial laparotomy, 30 patients (27.2%) had nonoptimal debulking at initial laparotomy, 20 patients (18.1%) had an "inoperable" disease at initial laparotomy, and 40 patients (36.3%) had such poorly written records that no information about the degree of resectability at initial laparotomy could be obtained. Four patients, in whom the residual tumor left at initial laparotomy had responded to chemotherapy, had a second laparotomy. In all four patients optimal debulking surgery at second laparotomy was easy to perform and was successful. The value of a second laparotomy after a few cycles of chemotherapy in order to optimally debulk the residual tumor left at initial laparotomy is discussed. It is concluded that a second attempt of debulking surgery after chemotherapy has a respectable place in the management of patients with advanced-state epithelial ovarian carcinoma, but further research is needed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Cervical cancer in Jewish women.

Because of the known low incidence rate of cervical cancer in Jewish women, less than appropriate attention has been focused on this type of malignancy in Jewesses. We have summarized our experience with 144 cases of cervical cancer diagnosed during 25 years in South Israel. In recent years a remarkable, although not statistically significant, increase in the number of patients with cervical cancer could be observed. Only two of ten patients were diagnosed at preinvasive stage. In contrast with previous reports we did not find women of Asian and African origin to be overrepresented, but patients from these origins were more often diagnosed at a higher stage than were patients of European origin. Adenocarcinoma accounts for almost 19% of the cervical cancer in premenopausal women. A very low rate of early detection of cervical cancer and a trend of rising incidence of cervical cancer in Jewish women urgently require a reevaluation of health care policy. Large-scale screening programs, perhaps initially in defined high-risk groups are needed.

Adenocarcinoma↗
PubMed1989

Serum IgG and IgA antibodies to Chlamydia in ectopic pregnancies.

The possible association of Chlamydia trachomatis with ectopic pregnancies was evaluated in a case-control study, comprising 35 women with ectopic pregnancy and 294 apparently healthy women who served as controls. Chlamydia-specific IgG and IgA antibodies were determined by single serovar (L2) inclusion immunoperoxidase assay (IPA). Socio-demographic characteristics, gynecological history and contraceptive methods were also evaluated. An inverse relationship was found between the educational levels and the prevalence of IgG and IgA antibodies to chlamydia. The prevalence rate of elevated IPA IgG (titer greater than or equal to 128) and IPA IgA (titer greater than or equal to 16) specific to chlamydia was significantly higher in women with ectopic pregnancy versus controls (32% vs 8%, respectively, for IgG: odds ratio = 4.9; and 26% vs 4% for IgA: odds ratio = 7.5). Chlamydia trachomatis was not isolated in cell cultures in 10 specimens available from fallopian tubes of women with ectopic pregnancy. Only 9% of the women recall having pelvic inflammatory disease (PID) indicating that most of the infections were asymptomatic. Women who did not use IUD had a higher proportion of chlamydia-specific IgG and IgA seropositives, though not statistically significant, as compared to IUD users. This study further supports the hypothesis that subclinical infection of the tube with C. trachomatis may underlie ectopic pregnancies.

Adolescent↗
PubMed1989

Synchronous carcinomas of endometrium and ovary.

Five cases of synchronous carcinomas of uterine endometrium and ovary are reported. All uterine cancers were typical endometrial adenocarcinomas. Among the ovarian cancers, four were serous papillary cystadenocarcinomas and one was an endometrioid carcinoma. There is much controversy with respect to staging and management of such cases since these tumors may represent either two synchronously occurring primaries or a single primary with metastases. It is suggested that when each tumor is confined within the limits of its tissue of origin the tumors may be considered as two separate primaries and surgery may be less aggressive. When there is evidence that at least one tumor is spreading to adjacent tissues and organs the question of two separate primaries or one metastatic tumor becomes academic only and aggressive surgical treatment with adjuvant chemotherapy is indicated.

Adenocarcinoma↗