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Biomedical subjects

D M Sherer

Publications and source records attributed to D M Sherer.

At least 109 records · Page 6Linked to original sources
PubMed1996

Angiogenesis in squamous cell carcinoma in situ and microinvasive carcinoma of the uterine cervix.

OBJECTIVE: To evaluate angiogenesis in squamous cell carcinoma in situ (CIS) and microinvasive squamous cell carcinoma of the uterine cervix and to investigate the relations among angiogenesis, stromal inflammation, and depth of invasion. METHODS: Three groups of women were studied: 22 controls who had undergone hysterectomy for benign conditions; 18 with squamous cell CIS of the cervix who underwent cone biopsy, hysterectomy, or both; and 14 with microinvasive squamous cell carcinoma who underwent conization of the cervix and subsequent surgical management according to depth of invasion. All specimens were stained immunohistochemically for factor VIII-related antigen. Areas below the basement membrane with the highest angiogenic density were selected. The degree of stromal inflammatory reaction was assessed. Statistical analyses included Kruskal-Wallis, analyses of variance and covariance, Scheffe and Bonferroni-Dunn post hoc procedures, and Pearson correlation analysis. P < .05 was considered statistically significant. RESULTS: Microvessel counts per high-power field (x 400) of microinvasive squamous cell carcinoma of the cervix differed significantly from those of controls and squamous cell CIS (median 34.5 per high-power field, range 9-76 versus median 17, range 7-47, and median 19, range 8-39, respectively; P < .005). Microvessel counts per high-power field in squamous cell CIS did not differ significantly from those of controls (P = .91). Among patients with microinvasive squamous cell carcinoma of the cervix, no significant correlation was found between microvessel counts per high-power field and the depth of invasion (r = 0.19, P = .51). Stromal inflammatory reaction (graded 0-3) differed significantly among controls, squamous cell CIS, and microinvasive carcinoma (mean 0.40, 0.83, and 1.64, respectively; P < .005). CONCLUSIONS: Microinvasive squamous cell carcinoma of the uterine cervix is angiogenic, but depth of invasion is not associated with increased angiogenicity. Squamous cell CIS is not angiogenic.

Adult↗
PubMed1996

Prenatal color and pulsed Doppler sonographic documentation of intrathoracic umbilical vein and ductus venosus, confirming extensive hepatic herniation in left congenital diaphragmatic hernia.

Prenatal sonographic diagnosis of an unusual case of a large left congenital diaphragmatic hernia is presented. The fetal stomach was located within the right thorax, posterior to the dextropositioned heart. Color and pulsed Doppler ultrasonography documented intrathoracic umbilical vein and ductus venosus vessels and respective waveforms, confirming extensive herniation of the left hepatic lobe.

Adult↗
PubMed1996

Spontaneous torticollis in a breech-presenting fetus delivered by an atraumatic elective cesarean section: a case and review of the literature.

A non-laboring patient with a breech-presenting fetus and oligohydramnios at 41 weeks' gestation underwent elective cesarean delivery. The infant was delivered atraumatically through a wide transverse incision of the lower uterine segment. Severe leftsided torticollis was noted immediately at delivery. The torticollis subsequently responded to physiotherapy with minimal residual facial asymmetry. This case and the literature suggest that torticollis itself may predispose to breech presentation. Alternatively, in the case presented, oligohydramnios with subsequent restricted posture may have contributed to the underlying pathophysiology of this phenomena, which previously has been noted as associated with and as a possible sequela of traumatic vaginal breech delivery.

Adult↗
PubMed1996

Midtrimester genetic amniocentesis of a twin gestation complicated by immediate severe fetal bradycardia with subsequent associated fetal anomalies.

We present an unusual complication of midtrimester genetic amniocentesis of a monochorionic twin gestation in which prolonged fetal bradycardia of 60 to 80 beats per minute sustained over two hours was associated with multiple subsequent fetal anomalies. These included: microcephaly, bilateral closed-lip schizencephaly, duodenal atresia, and complete paresis of the left upper extremity. Etiology of the fetal bradycardia was unclear. Fetal hemorrhage was not visualized despite targeted, continued real-time ultrasonography and was therefore considered an unlikely etiology. Although the bradycardia and associated hypoperfusion could alone explain the fetal outcome, destabilization of hemodynamics of a communicating vessel, resulting in a possible (although unproven) acute twin-twin transfusion induced at the time of amniocentesis due to decreased intra-amniotic pressure in association with a velamentous umbilical cord insertion could have led to this unusual occurrence.

Abnormalities, Multiple↗
PubMed1996

Decreased amniotic fluid volume at < 32 weeks of gestation is associated with decreased fetal movements.

The objective of this study was to assess the relationship between amniotic fluid volume (AFV) and fetal movements at < 32 weeks gestation as assessed by routine biophysical profile (BPP). From a database of 465 consecutive nonhypertensive, nondiabetic patients delivering at < 32 weeks gestation, patients with singleton, nonanomalous fetuses with AFV and fetal movements determined as part of a BPP assessment within 24 hours of delivery were studied. Amniotic fluid volume was scored 0 to 2, according to the following criteria: largest pocket in vertical diameter < 1 cm = 0; < 2 but > 1 cm = 1; > or = 2 cm = 2. Fetal movements (FM) were scored over 30 minutes: 0 if absent, 1 if 1 to 2 movements, 2 if > or = 3 gross (limb/trunk) movements. Variables assessed included fetal presentation, gestational age (GA), premature rupture of membranes (PROM) as a principal indication for delivery, clinical chorioamnionitis (diagnosed by previously published criteria), histologic parameters of infection (in amnion and umbilical cord assessed by a single pathologist blinded to clinical data), and neonatal outcome. Statistical analyses included contingency tables and analysis of variance with p < 0.05 considered significant. Three hundred and fifty-two patients met the inclusion criteria. One hundred and sixty-seven patients (47%) had PROM as a primary indication for delivery. Infrequently, decreased fetal well-being manifested by a BPP < 7 of 10 points was an indication for delivery despite prematurity (n = 7). Of the 352 patients, 80 (23%) had AFV = 0, 60 (17%) had AFV = 1, and 212 (60%) had AFV = 2; and 12 (3%) had FM = 0, 30 (9%) FM = 1, and 310 (88%) FM = 2. There was a significant correlation between decreased AFV and decreased fetal movements (p < 0.0001). Fetal presentation and GA were not significantly different between patients based on score of fetal movements. The incidence of clinical chorioamnionitis was significantly greater in patients with FM = 0 (p < 0.005). We conclude that decreased AFV is associated with decreased fetal movements irrespective of fetal presentation or gestational age. Neonatal outcome (umbilical vasculitis, sepsis, intraventricular hemorrhage) is affected only in unusual cases in which otherwise uncompromised (nonhypoxic, nonacidotic) fetuses have low scores on both these antepartum ultrasonographic parameters.

Amniotic Fluid↗
PubMed1996

Successful treatment of recurrent non-immune hydrops secondary to fetal hyperthyroidism.

BACKGROUND: Non-immune fetal hydrops is a heterogeneous disorder with a mortality rate of 50-98%. Resolution of non-immune fetal hydrops is rare but has been reported to occur spontaneously or after targeted therapeutic measures. CASE: A euthyroid gravida with Graves disease presented with a history of three prior perinatal deaths between 26 and 28 weeks' gestation, all associated with fetal hydrops. In the current pregnancy, the fetus developed hydrops at 24 weeks' gestation. Fetal hyperthyroidism, with high-output cardiac failure, was diagnosed with fetal blood sampling. After maternal therapy with propylthiouracil, resolution of the non-immune hydrops were documented and a healthy neonate subsequently delivered to term. The neonate developed transient hyperthyroidism after delivery, which required treatment for 10 weeks. CONCLUSION: Non-immune hydrops occurring as a result of fetal hyperthyroidism with high output cardiac failure is treatable with propylthiouracil.

Adult↗
PubMed1995

Histologic evidence of old intrauterine bleeding is more frequent in prematurity.

OBJECTIVE: Our purpose was to study the incidence and location of histologic evidence of intrauterine bleeding in preterm and term placentas. STUDY DESIGN: A total of 462 consecutive placentas delivered at < 32 weeks' gestation, from which cases of placenta previa, stillbirth, and multiple gestation were excluded, were compared with 108 consecutive term placentas (with similar exclusion criteria) in regard to the presence of hemosiderin in decidua of basal plate or placental membranes. Of the 462 preterm cases, 448 charts made specific reference to the presence or absence of vaginal bleeding. Bloody show alone was not considered bleeding. The blinded scoring of lesions (including acute ascending infection, uteroplacental vascular pathologic processes and related ischemic damage, chronic inflammation, and coagulation related lesions) was analyzed by contingency tables (p < 0.05 significant). RESULTS: A total of 196 of 462 (43%) preterm placentas had any decidual hemosiderin compared with one of 108 (0.8%) at term (p < 0.00001). Among the preterm cases, hemosiderin was significantly more common in preeclampsia (45/76, 60%) and in cases clinically diagnosed as nonhypertensive abruptio placentae (21/33, 64%) than in premature membrane rupture (72/192, 37.5%) and preterm labor (58/161, 36%, p < 0.003). The incidence of placental lesions in preterm cases with extraplacental membrane hemosiderin was not different than it was in cases without hemosiderin. Placental lesions related to basal-plate decidual hemosiderin in the preterm cases were villous infarct (p < 0.0001), uteroplacental vessels with absence of physiologic change (p < 0.003) and increased numbers of circulating nucleated erythrocytes (p < 0.0007), uteroplacental thrombosis (p < 0.0001), and villous fibrosis (p < 0.0001) and hypovascularity (p < 0.0001). Among the preterm cases, 23 of 48 (48%) with first-trimester bleeding, 33 of 66 (50%) with second-trimester bleeding, and 31 of 64 (48%) with multiple episodes of bleeding had decidual hemosiderin (p < 0.0001). A clinical history of gestational bleeding was significantly less common in cases of preterm preeclampsia with histologic evidence of bleeding (four of 73, 5.5%) than in nonhypertensive abruptio placentae (18/31, 58%), premature rupture of membranes (52/183, 28%), or preterm labor (31/161, 19%, p < 0.0001). Hemosiderin was not related to clinical bleeding < 72 hours of delivery (p > 0.20). CONCLUSIONS: Decidual bleeding is common in all clinical types of preterm birth and is most common in preterm preeclampsia and nonhypertensive abruption placentae. A clinical history of bleeding is not correlated with the presence of decidual hemosiderin. Bleeding in the basal plate is related to histologic evidence of chronic uteroplacental vascular pathologic processes, which in cases of spontaneous prematurity (premature rupture of membranes, preterm labor, nonhypertensive abruptio placentae) may be associated with decidual bleeding which occasionally may be clinically manifested as gestational bleeding.

Abruptio Placentae↗
PubMed1995

Recurrent transient superior vena cava-like syndrome possibly associated with megestrol acetate.

BACKGROUND: Superior vena cava syndrome is a rare, life-threatening clinical entity associated with occlusion of venous outflow from the head, neck, and upper extremities; this syndrome produces facial edema, cyanosis, dyspnea, and prominent neck veins, and is usually caused by intrathoracic neoplasms. CASE: In this unusual case, a patient receiving megestrol acetate for stage IV endometrial carcinoma developed recurrent transient superior vena cava-like syndrome in the absence of venous obstruction. CONCLUSION: Superior vena cava-like syndrome may occur with megestrol acetate. This unusual complication should be considered in patients receiving this medication who present with symptomatology similar to that of superior vena cava syndrome.

Adenocarcinoma↗
PubMed1995

Angiogenesis in endometrial hyperplasia and stage I endometrial carcinoma.

OBJECTIVE: To evaluate angiogenesis in endometrial hyperplasia and stage I endometrial carcinoma, and to investigate the relationship between angiogenesis and tumor grade and depth of invasion. METHODS: Three groups of patients were analyzed: control patients who underwent hysterectomy for benign conditions (n = 19), patients with endometrial hyperplasia (n = 24), and patients with stage I endometrial carcinoma (n = 34). All hysterectomy specimens were stained immunohistochemically for factor VIII-related antigen as a sensitive and specific marker for vascular endothelium. Areas close to the deepest myometrial invasion or those with the highest grade of endometrial hyperplasia and the highest angiogenic intensity were selected. Three fields (x 400) were selected for each slide, and the mean microvessel count was calculated. Statistical analysis included Mann-Whitney U test or Kruskal-Wallis analysis of variance and Dunn post hoc procedure. P < .05 was considered significant. RESULTS: A significant difference was found between the microvessel count of controls versus the group with complex endometrial hyperplasia (median 21, range 16-80, versus median 38, range 20-130; P < .05). Microvessel counts of complex endometrial hyperplasia were significantly higher than those of simple hyperplasia (median 25, range 16-42; P < .05) and significantly lower than counts of endometrial carcinoma (median 77.5, range 19-189; P < .05). Microvessel counts in complex hyperplasia were not significantly different than those of noninvasive stage I endometrial carcinoma (median 38, range 20-130, versus median 44, range 19-119; P = .5). In cases of stage I endometrial carcinoma, a higher number of microvessels was noted in specimens with myometrial invasion than in those without myometrial invasion (median 44, range 19-119, versus median 83, range 19-189; P < .01). A higher number of microvessels was noted in cases with grade 2 than in those with grade 1, stage I endometrial carcinoma (median 44, range 19-98, versus median 96, range 63-189; P < .001). CONCLUSION: Complex endometrial hyperplasia and endometrial carcinoma are angiogenic. Furthermore, in stage I endometrial carcinoma, greater depth of invasion and higher tumor grade are directly correlated with angiogenic intensity.

Endometrial Hyperplasia↗
PubMed1995

Prenatal ultrasonographic diagnosis of ductus arteriosus aneurysm with spontaneous neonatal closure.

Aneurysm of the ductus arteriosus may be either spontaneous or acquired as a complication of surgical closure of a patent duct. Patients may be asymptomatic or present with a wide spectrum of symptoms, including hoarseness, respiratory symptoms, aortic or pulmonary thrombosis or embolism, or rupture of the aneurysm. We present the first report of prenatal ultrasonographic diagnosis of isolated ductus arteriosus aneurysm. The aneurysm presented at 39 weeks as an enlarged, dilated, vascular structure 15 mm in diameter, which began at the bifurcation of the main pulmonary artery and ended in the descending aorta. Doppler imaging demonstrated turbulent flow in this lesion. Following spontaneous delivery, a bidirectional shunt in the ductus arteriosus was found on the 1st day, but the caliber of the vessel was normal. An almost completely functionally closed ductus was found on the 2nd day. Spontaneous resolution of the lesion was confirmed by magnetic resonance imaging at 4 weeks of age.

Adult↗
PubMed1995

Lack of mandibular movement manifested by absent fetal swallowing: a possible factor in the pathogenesis of micrognathia.

This study was performed to assess the association of lack of mandibular movement as manifested by absent fetal swallowing and micrognathia in a nonrestrictive intrauterine environment. Over a 5-year period, 14 fetuses with sonographic findings of polyhydramnios (amniotic fluid index [AFI] more than 20 cm), absent mandibular movement, and a nonvisualized fetal stomach, all consistent with absent fetal swallowing, were followed. A group of 14 fetuses, each with polyhydramnios (AFI more than 20 cm), yet with sonographic detection of fetal swallowing, served as controls. All gravidas in both groups were normoglycemic throughout gestation. Subsequent mandibular development was assessed at delivery or autopsy. Analysis of the data revealed that in the study group, 12 of these infants were liveborn, and two were stillborn. Eleven of the liveborn infants had an early neonatal death. All 14 infants of the study group demonstrated micrognathia. None of the control infants (all of whom survived) had micrognathia. In conclusion, this study supports the concept that normal mandibular growth may depend on the presence of mandibular movement during intrauterine development.

Adult↗
PubMed1995

Prenatal diagnosis of moderate unilateral hydrocephalus subsequently not requiring neonatal decompression.

Prenatal diagnosis of unilateral hydrocephalus is unusual. In the past most such cases have been treated with neonatal shunting procedures. We present an unusual case in which moderate unilateral hydrocephalus was diagnosed prenatally at 30 weeks' gestation. Despite prenatal and neonatal sonographic signs of both cortical thinning and mild displacement of midline intracranial structures, confirmed by computed tomography, neonatal shunting was not required. The findings and course in this unusual case suggest that infrequently some of the milder cases of idiopathic nonprogressive unilateral hydrocephalus discovered later in life may possibly represent late detection of this preexisting condition.

Adult↗
PubMed1995

Prenatal sonographic diagnosis and subsequent conservative surgical management of bilateral ureteroceles.

Prenatal sonographic diagnosis of ureteroceles usually involves clearly duplicated urinary collecting systems associated with ectopic ureters draining the upper renal moieties. We present an unusual case in which an initial sonographic examination was consistent with bilateral orthotopic ureteroceles in association with bilateral single renal systems. The possibility of single systems raised perinatal considerations unique to this anomaly. Repeat prenatal sonography was suggestive of duplex systems and subsequently confirmed as such by neonatal ultrasound and voiding cystourethrogram. At the age of 1 month, the infant underwent bilateral ipsilateral ureteroureterostomy with conservation of the bilateral dilated upper renal moieties. We discuss the possible pathophysiology underlying the different conflicting sonographic findings and address current management of such lesions.

Adult↗
PubMed1995

Prenatal sonographic diagnosis of Treacher Collins syndrome: a case and review of the literature.

We report the prenatal ultrasonographic diagnosis of a fetus with mandibulofacial dysostosis (Treacher Collins syndrome). Sonographic findings included: polyhydramnios, microcephaly, abnormal fetal facial features (slanting forehead, microphthalmos, micrognathia), and abnormal fetal swallowing. A review of the current literature pertaining to prenatal diagnosis of this condition is presented.

Adolescent↗
PubMed1995

Adjuvant chemotherapy in stage IB neuroendocrine small cell carcinoma of the cervix.

BACKGROUND: Neuroendocrine small cell carcinoma of the cervix is a very rare and aggressive tumor which tends to metastasize early. This tumor is similar histologically to small cell carcinoma of the lung. Conventional treatment with surgery and/or radiation therapy has not been successful and has prompted the use of adjuvant chemotherapy regimens similar to those used for small cell carcinoma of the lung. METHODS: Three patients with Stage IB neuroendocrine small cell carcinoma of the cervix treated with postoperative adjuvant chemotherapy consisting of cisplatinum and VP-16, were identified. Analysis of the outcome of these three patients and a review of the current literature were performed. RESULTS: Median survival was 28 months. Two patients received pelvic radiation therapy, one due to positive surgical margins and the other due to recurrent disease. Currently two patients are alive and free of disease at 17 and 61 months. The third patient developed hepatic and pelvic recurrence and died 30 months after her presentation and 18 months after recurrence. CONCLUSION: The outcome of our three patients and eight similar cases in the literature suggest an improved survival rate with adjuvant chemotherapy compared to conventional treatment with surgery and or radiation therapy.

Adult↗