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F Amant

Publications and source records attributed to F Amant.

At least 37 records · Page 2Linked to original sources
PubMed2001

Pseudo-Meigs' syndrome caused by a hydropic degenerating uterine leiomyoma with elevated CA 125.

BACKGROUND: Uterine leiomyomas rarely cause pseudo-Meigs' syndrome with elevated serum CA 125 levels. CASE: A 39-year-old patient with a large uterine leiomyoma is described. The associated massive ascites, pleural fluid, and increased CA 125 level all seemed to be related to the uterine tumor. Hydropic degenerating leiomyomas are characterized by focal accumulation of edema and collagen deposition. Marked degrees of hydropic degeneration may have resulted in cystic degeneration, leading to large myometrial cysts. A presumed direct relation between the abundance of intratumoral fluid and presence of ascites seemed justified. The increased level of CA 125 most probably resulted from the peritoneal mechanical irritation from the large leiomyoma or from a large volume of ascites. Having accumulated a sufficient volume and pressure, the ascites finds it way through the diaphragm through intercellular gaps and diaphragmatic apertures, as well as through small bilateral areas where muscular tissue of the diaphragm is replaced by areolar tissue, resulting in the presence of pleural fluid. CONCLUSION: The pathophysiology of a uterine leiomyoma mimicking a pelvic malignancy is described.

Adult↗
PubMed2001

Uterine carcinosarcoma with melanocytic differentiation.

A 65-year-old black woman was found to have a 3.0 cm endometrial tumor that was a carcinosarcoma with a major epithelial and a less prominent mesenchymal component. The latter was undifferentiated but one focus of chondroid differentiation was noted. The former showed papillary serous differentiation. Melanin pigment was observed in both epithelial and mesenchymal components. Staining with antisera to S100 protein and HMB-45 confirmed the presence of melanocytes. An endocervical focus of tumor also contained melanin. Electron-microscopic studies showed large tumor cells with an irregularly indented nucleus and abnormal giant cytoplasmic melanosomes. Only one case of uterine carcinosarcoma with melanocytic differentiation has been previously reported.

Aged↗
PubMed2001

Uterine sarcomas in South African black women: a clinicopathologic study with ethnic considerations.

BACKGROUND: There is considerable evidence for a higher incidence of uterine sarcomas in blacks when compared to whites. However, whether this higher incidence is related to differences in clinicopathologic presentation is not known. PATIENTS AND METHODS: We reviewed slides and clinical charts of 81 patients with a primary diagnosis of uterine sarcoma referred between 1991 and 1999 to Kalafong Academic and Pretoria Academic Hospital. After review, 49 cases remained for study. RESULTS: Uterine sarcomas were distributed between leiomyosarcoma (LMS) (39%), carcinosarcoma (CS) (49%) and endometrial stromal sarcoma (ESS) (12%). LMS and ESS tend to present at an earlier age when compared to CS (respectively p < 0.008 and 0.02). Of women with LMS more women are premenopausal when compared to CS (p < 0.009). Lower abdominal pain is more common in LMS (p < 0.009), whereas bleeding is more common in women suffering from CS (p < 0.01). Lymphovascular space involvement and cervical involvement are more common in CS when compared to LMS. In CS, the carcinoma component has most of the metastatic potential. CONCLUSION: Among black South African women different clinicopathologic features for uterine LMS, CS and ESS are observed. We also present genetic and/or hormonal factors possibly contributing to the pathophysiology of uterine sarcomas in blacks.

Age Factors↗
PubMed1999

Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience.

OBJECTIVE: The aim of the study was to evaluate the subjective assessment of ultrasonographic images for discriminating between malignant and benign adnexal masses. STUDY DESIGN: The study was prospective. Initially, one ultrasonographer preoperatively assessed 300 consecutive patients with adnexal masses. Subsequently, the recorded transparent photographic prints were independently assessed by five investigators, with different qualifications and level of experience, who were also given a brief clinical history of the patients (i.e. the age, menstrual status, family history of ovarian cancer, previous pelvic surgery and the presenting symptoms). The diagnostic performance of the observers was compared with the histopathology classification of malignant or benign tumors. The end-points were accuracy, interobserver agreement and the possible effect of experience. RESULTS: The first ultrasonographer and the most experienced investigator both obtained an accuracy of 92%. There was very good agreement between these two investigators in the classification of the adnexal masses (Cohen's kappa 0.85). The less experienced observers obtained a significantly lower accuracy, which varied between 82% and 87%. Their interobserver agreement was moderate to good (Cohen's kappa 0.52 to 0.76). CONCLUSION: Experienced ultrasonographers using some clinical information and their subjective assessment of ultrasonographic images can differentiate malignant from benign masses in most cases. The accuracy and the level of interobserver agreement are both correlated with experience. About 10% of masses were extremely difficult to classify (only < 50% of assessors were correct).

Adnexal Diseases↗
PubMed1999

Misoprostol compared with methylergometrine for the prevention of postpartum haemorrhage: a double-blind randomised trial.

OBJECTIVE: To compare the efficacy and side effects of misoprostol, compared with methylergometrine, for the prevention of postpartum haemorrhage. DESIGN: A double-blind, randomised clinical trial of 200 women with apparently normal pregnancies. SETTING: University teaching hospital. PARTICIPANTS: Two hundred women with apparently normal pregnancies. METHODS: After the baby had been born, all women received two capsules by mouth and the contents of an ampule by intravenous injection. Each woman only received one active product. The capsules contained either a total of 600 microg misoprostol or placebo, and the ampule 200 microg of methylergometrine or placebo. MAIN OUTCOME MEASURES: Need for further oxytocic drugs, blood pressure, the presence of side effects, mean haemoglobin and haematocrit three days after delivery. RESULTS: Two hundred women completed the study (100 received methylergometrine and 100 misoprostol). Postpartum haemorrhage occurred in 4.3% of the methylergometrine group and 8.3% of the misoprostol group (P = 0.57). The need for further oxytocic drugs was 4.4% and 12.8% after methylergometrine and misoprostol, respectively (P = 0.065). One hour after the birth of the baby there was no difference in the mean systolic blood pressure (117 +/- 12 mmHg versus 115 +/- 11 mmHg) (P = 0.26) or the mean diastolic blood pressure (72 +/- 10 mmHg versus 71 +/- 11 mmHg for the groups receiving methylergometrine or misoprostol, respectively) (P = 0.97). The mean temperature in the misoprostol group rose to 37.4 degrees C, compared with 37 degrees C in the methylergometrine group (P < 0.0001). In the misoprostol group 34% developed fever (> 38 degrees C) compared with 3% in the methylergometrine group (P < 0.0001). Shivering (visual analogue score > or = 8) also occurred more often after misoprostol (42%) than after methylergometrine (8.5%) (P < 0.0001). The haemoglobin level (g/dL) on the third postpartum day was similar for both groups ( 11.0 and 11.2 for methylergometrine and misoprostol, respectively) (P = 0.39). CONCLUSIONS: This study suggests that although protection from postpartum haemorrhage using parenteral methylergometrine and oral misoprostol is nearly equal, misoprostol is associated with more side effects.

Administration, Oral↗
PubMed1998

Gastrostomy using a "Gastrofix" as an alternative for nasogastric tubes in ovarian cancer surgery.

OBJECTIVE: The aim of this study was to evaluate the use of a gastrostomy instead of a nasogastric tube following surgery for advanced ovarian cancer. DESIGN: This was a retrospective observational study. SETTING: The study was performed in a university teaching hospital. PARTICIPANTS: Thirty-four women undergoing debulking surgery for ovarian carcinoma participated. METHODS: In order to increase patients' comfort during the first postoperative days we inserted for gastric decompression a transcutaneous instead of a transnasal tube following debulking surgery. Only patients with bowel involvement and/or extensive tumor load in the upper abdomen were included in the study. In this study we report on the use of a gastrostomy using a Cystofix drainage catheter, resulting in what we call a "Gastrofix." The Gastrofix was placed in 34 patients with ovarian cancer. In 32 (94%) patients an extraperitoneal hysterectomy and bilateral salpingo-oophorectomy was performed, in 16 (47%) a resection of the diaphragmatic peritoneum, in 14 (41%) patients a paraaortic lymphadenectomy, and in 12 (35%) patients part of the bowel was resected. RESULTS: Free oral liquid intake and poor fiber diet were started after 5.5 days (median, range from 3-8 days) and 8 days (median, range from 4-12 days), respectively. The catheter was clamped off after 5 days (median, range from 2-8 days) and removed after 7 days (median, range from 3-11 days). Of the 34 patients only 12 (35%) received antiemetics (median of 4 days, range from 1-7 days). In 1 patient (3%) pain at the insertion site was observed on the third and fourth postoperative days. In 3 patients (9%) some fluid leakage at the insertion site was noted. In 4 patients (12%) the catheter fell out prematurely on days 0, 4, 6, and 9, respectively. In none of the patients were infection or fistulas at the insertion site noted. In all patients there was a satisfactory drainage of gastric content. CONCLUSION: After debulking surgery, the use of a Gastrofix resulted in an adequate gastrointestinal decompression without major complications. This technique may increase the comfort of the patient during the postoperative phase considerably.

Equipment Design↗
PubMed1995

Abdominal pain in the postpartum: role of imaging.

The post-delivery evaluation of the obstetric patient presenting with severe abdominal pain can be a challenge to the obstetrician, the internist, and the radiologist. Besides non-pregnancy-related causes of abdominal pain, several pregnancy-related complications should be included in the list of differential diagnoses. Based on pathogenesis, these conditions can be divided in four categories: thromboembolic disease, infectious complications, mechanical complications, and complications of preeclampsia. Most disease processes can be adequately visualized with sonography. CT can be indicated for the evaluation of the extent of ovarian vein thrombosis and for depiction of deep abdominal collections in obese patients or in cases of abundant overlying abdominal gas. MRI can be useful to provide the specific diagnosis of hemorrhagic liver infarction in the clinical setting of a HELLP syndrome.

Abdominal Pain↗
PubMed1989

AIF4-induced inhibition of the ATPase activity, the Ca2+-transport activity and the phosphoprotein-intermediate formation of plasma-membrane and endo(sarco)plasmic-reticulum Ca2+-transport ATPases in different tissues. Evidence for a tissue-dependent functional difference.

AIF4- inhibits the (Ca2+ + Mg2+)-ATPase activity of the plasma-membrane and the sarcoplasmic-reticulum Ca2+-transport ATPase [Missiaen, Wuytack, De Smedt, Vrolix & Casteels (1988) Biochem. J. 253, 827-833]. The aim of the present work was to investigate this inhibition further. We now report that AIF4- inhibits not only the (Ca2+ + Mg2+)-ATPase activity, but also the ATP-dependent 45Ca2+ transport, and the formation of the phosphoprotein intermediate by these pumps. Mg2+ potentiated the effect of AIF4-, whereas K+ had no such effect. The plasma-membrane Ca2+-transport ATPase from erythrocytes was 20 times less sensitive to inhibition by AIF4- as compared with the Ca2+-transport ATPase from smooth muscle. The endoplasmic-reticulum Ca2+-transport ATPase from smooth muscle was inhibited to a greater extent than the sarcoplasmic-reticulum Ca2+-transport ATPase of slow and fast skeletal muscle.

Adenosine Triphosphatases↗
PubMedDate not supplied

Microsatellite instability in uterine sarcomas.

Studies have shown a 15-30% frequency of microsatellite instability in endometrial cancer. In addition, we found a 21% frequency of microsatellite instability in endometrial cancer. Our aim was to investigate the presence of microsatellite instability and loss of heterozygosity in uterine sarcomas. The records of 69 women referred to Kalafong Academic and Pretoria Academic Hospital with a primary diagnosis of uterine sarcoma were reviewed. At histological review of 43 cases with a primary diagnosis of leiomyosarcoma, diagnosis of mitotically active leiomyoma was made in 21. Diagnosis of carcinosarcoma was made in 21 cases and endometrial stromal sarcoma in five. In all cases, genomic DNA was extracted from normal myometrium and tumor and analyzed for microsatellite instability and loss of heterozygosity. High-frequency microsatellite instability was absent in leiomyosarcoma, endometrial stromal sarcoma, and mitotically active leiomyomas and was observed in 1 (5%) carcinosarcoma. Loss of heterozygosity for chromosome 11 was present in 8/48 (17%) of uterine sarcomas, equally distributed between leiomyosarcomas (4/22 = 18%) and carcinosarcomas (4/21 = 19%). There was no loss of alleles in endometrial stromal sarcoma nor mitotically active leiomyomas. In conclusion, it is suggested that tumor suppressor genes may play a role in the tumorigenesis of uterine mesenchymal cells, whereas mismatch repair genes contribute to the carcinogenesis of endometrial cancer.

Carcinosarcoma↗
PubMedDate not supplied

Laparoscopic lower para-aortic staging lymphadenectomy in stage IB2, II, and III cervical cancer.

The presence of metastases in the para-aortic lymph nodes has important implications in the management of cervical carcinoma in many centers. In this study we investigated the role of laparoscopic lower para-aortic lymphadenectomy in patients with cervical carcinoma. In 42 consecutive patients with stage IB2-IIIB cervical carcinoma without suspicious para-aortic lymph nodes on CT scanning, a laparoscopic lower para-aortic lymphadenectomy was performed between January 1998 and April 2001. The transperitoneal route was used in the first 21 patients, and in the remaining 21 patients the procedure was started with the left retroperitoneal approach. The number of patients with stage IB2, II, and III was 7, 30, and 5, respectively. The median age was 51 years (range 30-81). The median weight and length were 62 kg (range 45-83) and 162 cm (range 150-175), respectively. In four patients-two operated via the transperitoneal route and the other two operated via the retroperitoneal route-the procedure was abandoned, in three patients because of adhesions following prior surgery and in one because of a camera failure. Conversion from the retropertitoneal to the transperitoneal approach was necessary because of a peritoneal tear in five of the 21 cases (all of them in the first 10 cases). Median estimated blood loss during the operation was 78 ml (range 10-300). The median hemoglobin (Hb) decrease was 1.3 g/dL (range 0-3.7). The median duration of the procedure was 64 min (range 20-115). Lymphadenectomy was stopped when one of the nodes was positive on frozen section. The number of para-aortic lymph nodes removed ranged from one to 15 (median 6). In seven (18%) of the 38 patients with successful lymphadenectomy, para-aortic metastases were observed (stage IB2, 1/6; stage II, 5/28 and stage III, 1/4). The only major complication was the development of a retroperitoneal hematoma on the first postoperative day in one patient (Hb fall of 3.7 g/dL). Patients with para-aortic lymph node metastases were treated with extended field para-aortic radiotherapy. None of these developed bowel obstruction. The median follow-up was 15 months (range 1-40 months). Actuarial 1-year crude survival was 88% and 33%, respectively, for patients with negative and positive para-aortic nodes. Laparoscopic para-aortic staging in cervical carcinoma is feasible with low morbidity. Eighteen percent of the patients, without suspicion of para-aortic metastases on CT, proved to have metastases in the lower para-aortic region.

Adenocarcinoma↗
PubMedDate not supplied

Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions.

The focus of this study was to document postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Data from 172 consecutive patients with newly diagnosed carcinoma of the vulva were studied. One hundred and one patients primarily treated with modified radical vulvectomy and complete inguinofemoral lymphadenectomy using separate groin incisions (n = 187) were included in this study. One or more complications were documented in 77 of the 101 (76%) patients. Complications after groin dissection were observed in 66% of the patients. The main complications were wound breakdown (17%) and/or infection (39%) of the groin, lymphocyst formation (40%), and lymphedema (28%). In 98 of 187 (52%) groin dissections, one or more complications were documented. The presence of lymph node metastases, postoperative radiation, age older than 65 years, and removal of the vena saphena magna were not significant risk factors for the occurrence of complications. The occurrence of early complications after groin dissection was significantly related to the late-complication lymphedema (P = 0.002). Our results confirm relatively high rates of wound breakdown, infection, lymphocyst formation, and lymphedema even with separate groin incisions. The occurrence of early complications was related to lymphedema. No other risk factors could be identified.

Age Distribution↗
PubMedDate not supplied

Immunohistochemical expression of CD10 antigen in uterine adenosarcoma.

Uterine adenosarcoma (UAS) is microscopically characterized by a biphasic growth pattern. By definition, the epithelial component is benign, whereas the stromal component typically has the appearance of a low-grade sarcoma, usually an endometrial stromal sarcoma. CD10 acts by reducing cellular response to peptide hormones and is currently regarded as a specific marker for endometrial stromal tumors. In this international multicenter study, we further explored CD10 immunoreactivity in 30 UASs. We encountered CD10 positivity of the sarcomatous component in 18/20 (90%) of UASs, in five of eight (63%) of UASs with sarcomatous overgrowth as well as in both cases of recurrent UAS. The epithelial component stained negative in all cases. These findings suggest that CD10 can be used to differentiate UAS from cellular leiomyoma, or in case endometrial stromal cells exhibit muscle differentiation. Furthermore, CD10 positivity in recurrent UAS might guide the pathologist toward an endometrial stromal origin.

Adenosarcoma↗
PubMedDate not supplied

Port-site metastases after open laparoscopy: a study in 173 patients with advanced ovarian carcinoma.

Open laparoscopy was used to diagnose advanced ovarian cancer. Patients with a pelvic mass and an omental cake and/or large-volume ascites were selected for open laparoscopy. One hundred and seventy-three patients with stage III or IV ovarian carcinoma underwent diagnostic open laparoscopy. Seventy-one patients underwent complete excision of port sites at the time of debulking surgery. Thirty (17%) patients developed port-site metastases. However, only 8 (5%) of these port-site metastases were clinically diagnosed, while 22 out of 71 (31%) with complete port-site excision were diagnosed on pathologic examination. There was no significant relationship between the development of port-site metastases and median time to primary chemotherapy or surgery, the presence of ascites, or stage IV disease. All port-site metastases disappeared during primary therapy, and none of the patients developed a second relapse in one of their port sites. We observed a high rate of port-site metastases after laparoscopy in patients with advanced ovarian carcinoma. However, prognosis was not worse in this group of patients. Laparoscopy is a convenient technique to diagnose advanced ovarian carcinoma, to exclude other primary tumors, and to refer patients to a tertiary center.

Female↗
PubMedDate not supplied

Report of an unusual problematic uterine smooth muscle neoplasm, emphasizing the prognostic importance of coagulative tumor cell necrosis.

Follow-up data of the clinical behavior of uterine smooth muscle tumors with low malignant potential are scarce. We present a woman suffering from a uterine smooth muscle cell tumor with increased cellularity, absence of significant atypia, and two to three mitotic figures per 10 HPFs but with minimal focal coagulative tumor cell necrosis (CTCN). These microscopic features are currently accepted to label the lesion as a "smooth muscle neoplasm of low malignant potential, limited experience." After a disease-free survival of 4 years, two retroperitoneal tumors around the iliac vessels were extirpated. Both tumors consisted of smooth muscle cells with mild to moderate atypia and a mitotic index of 5-10 per 10 HPFs but with multifocal and extensive CTCN. These microscopic features were sufficient to establish the diagnosis of leiomyosarcoma. This case adds to the limited experience of the clinical behavior of problematic uterine smooth muscle cell neoplasms and underscores the prognostic importance of CTCN.

Female↗