[The family practitioner and the postcoital test].
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Adult↗
Biomedical subjects
F B Lammes
Publications and source records attributed to F B Lammes.
Human papillomavirus DNA in multicentric vulvar intraepithelial neoplasia.
Human papillomavirus (HPV) DNA in vulvar intraepithelial neoplasia (VIN) is associated with multifocality of VIN III and with multicentricity of other neoplastic squamous lesions in the cervix and vagina. The aim of this study was to establish the prevalence and type of HPV DNA in the lesions of vaginal intraepithelial neoplasia (VaIN) and cervical intraepithelial neoplasia (CIN) in patients with VIN III using the polymerase chain reaction (PCR). HPV DNA detection and histologic analysis were performed on alternating sections of paraffin-embedded biopsies of concomitant CIN and VaIN in 27 patients with VIN III. PCR was performed with consensus primers and HPV typing was performed by direct sequencing of the PCR amplimers. HPV DNA was detected in all VIN III lesions (93% contained HPV-16 DNA); in 96% of the CIN lesions (73% contained HPV-16 DNA); and in all VaIN lesions (75% contained HPV-16 DNA). The HPV type was not the same in 22% of the different lesions of VIN, CIN, and VaIN, even if the biopsies were taken at the same time.
Adult↗
Do mucin-secreting squamous cell carcinomas of the uterine cervix metastasize more frequently to pelvic lymph nodes? A case-control study?
Twenty-nine patients with stage IB/IIA squamous cell carcinoma of the uterine cervix who had positive pelvic nodes were matched with 29 cases of node-negative squamous cell carcinoma by depth of invasion and lymphovascular space invasion. By multivariate analysis, these criteria independently predicted pelvic node metastases. Intracellular mucin, demonstrated by alcian-blue staining at pH 2.5, was noted in 21 of the 58 patients (36%). The frequency of mucin-positive tumors was not significantly different between the patients and their controls (38 versus 34%, p = 0.78), nor was the degree of positivity. These results suggest that, although a substantial proportion of squamous cell carcinomas exhibit mucin secretion, patients with these tumors are not at increased risk for pelvic node metastases. We therefore do not recommend routine mucin staining in cervical squamous cell carcinomas.
Adult↗
[Treatment of genital prolapse in very old women].
An until recently mobile woman of 86 years developed problems with independent living because of a genital total prolapse. After treatment by high perineoplasty she was once more able to resume her social activities. In very old women a genital prolapse can lead to significant morbidity due to hygienic problems and increase of social loneliness due to impairment of mobility. Use of a pessary is rarely an acceptable solution because of ulceration of the vaginal wall. Surgery can be modified because preservation of vaginal function is hardly necessary after the age of eighty. Efficient control of complaints can be achieved by Labhardt high perineoplasty or Le Fort partial colpocleisis. Before such types of operation cytology and ultrasonography of the uterus must be performed to exclude a malignancy with reasonable certainty. Both operations can be done under local anaesthesia with very short hospitalization.
Aged↗
Surgical pathologic factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes.
BACKGROUND: The purpose of this analysis was to identify pathologic risk factors for recurrence and patterns of recurrence in patients with International Federation of Gynecology and Obstetrics Stage IB and IIA cervical carcinoma and negative pelvic lymph nodes after radical hysterectomy. METHODS: During the period 1982-1991, 271 clinically staged patients with Stage IB or IIA cervical carcinoma underwent a Wertheim-Okabayashi radical hysterectomy with pelvic lymph node dissection. The study group was composed of 196 lymph node negative patients. Pathology slides were reviewed and multivariate analysis performed to identify independent prognostic factors. RESULTS: The recurrence rate in the study group was 7.7%. In multivariate analysis, the following factors were identified as independent risk factors for recurrence: adenocarcinoma (P = 0.003), depth of invasion as a fraction of tumor penetration of the cervical stroma (P = 0.01), and an extensive stromal inflammatory cell infiltrate (P = 0.04). Based on these factors, the following risk groups were identified: a low risk group (N = 140, 5-year disease free interval [DFI] = 97%) and a high risk group (N = 55, 5-year DFI = 81%). An evaluation of the recurrence patterns for these patients showed a predominance of pelvic recurrences. CONCLUSIONS: This study showed that among patients with Stage IB and IIA cervical carcinoma and negative pelvic lymph nodes, a subset with a significant risk for recurrence could be identified. Because the majority of recurrences in the lymph node negative group were pelvic recurrences, the value of adjuvant radiotherapy as a treatment for selected lymph node negative patients should be evaluated in a prospective study.
Adenocarcinoma↗
Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy.
BACKGROUND: Laparoscopic salpingostomy is a well-established treatment for patients with tubal pregnancy who desire to retain fertility. Another approach that preserves the fallopian tube is medical treatment. We compared systemic methotrexate and laparoscopic salpingostomy in the treatment of tubal pregnancy. Outcome measures were treatment success, tubal preservation, and homolateral tubal patency. METHODS: Between January, 1994, and September, 1996, haemodynamically stable patients with laparoscopically confirmed unruptured tubal pregnancy and no signs of active bleeding were randomly assigned systemic methotrexate (four 1.0 mg/kg doses of intramuscular methotrexate alternated with 0.1 mg/kg oral folinic acid) or laparoscopic salpingostomy. Treatment success was defined as complete elimination of the tubal pregnancy (serum human chorionic gonadotropin < 2 IU/L) and preservation of the tube. Homolateral tubal patency was assessed by hysterosalpingography. Analysis was by intention to treat. FINDINGS: 100 patients were included in the trial. Of 51 patients allocated systemic methotrexate, 42 (82%) were successfully treated with one course; two (4%) patients needed a second course for persistent trophoblast. Surgical intervention was needed in seven (14%) patients; salpingectomy was necessary in five of these patients for tubal rupture. Of the 49 patients allocated laparoscopic salpingostomy, 35 (72%) were successfully treated by laparoscopic salpingostomy alone; salpingectomy was needed in four (8%) patients, and ten (20%) needed methotrexate for persistent trophoblast. The tube was preserved in 46 (90%) patients in the methotrexate group versus 45 (92%) in the salpingostomy group (rate ratio 0.98 [95% CI 0.87-1.1]). Homolateral tubal patency could be assessed in 81 patients: the tube was patent in 23 (55%) of 42 patients in the methotrexate group and in 23 (59%) of 39 patients in the salpingostomy group (rate ratio 0.93 [0.64-1.4]). INTERPRETATION: In haemodynamically stable patients with unruptured tubal pregnancy, systemic methotrexate and laparoscopic salpingostomy were successful in treating the majority of cases. We found no significant difference between the treatments in the homolateral patency rate. Subsequent fertility outcome has to be awaited to show which treatment yields better fertility prospects.
Adult↗
Identification of high-risk groups among node-positive patients with stage IB and IIA cervical carcinoma.
The purpose of the present study was to identify a subset of high-risk patients among surgically treated node-positive patients with stage IB and IIA cervical carcinoma. From 1982 through 1991, 334 patients underwent radical hysterectomy for FIGO stage IB and IIA cervical carcinoma. In 68 patients pathological analysis of the surgical specimen revealed positive pelvic nodes. In this group, a Cox proportional hazard analysis was performed to examine the prognostic significance of clinicopathological variables. Only for adenocarcinoma (P = 0.002) and parametrium infiltration (P = 0.003) was evidence of an association with prognosis found. Based on these two factors, patients with positive pelvic nodes were categorized into a low-risk group (squamous cell carcinoma without parametrium infiltration, N = 33) and a high-risk group (squamous cell carcinoma with parametrium infiltration or adenocarcinoma, N = 34). The 5-year disease-specific survival in the low-risk group was 94% compared with 60% in the high-risk group (P = 0.003). For patients in the high-risk group, there is an urgent need for alternative adjuvant treatment to improve outcome.
Adenocarcinoma↗
Radiographic aspects of office hysteroscopic tubal occlusion with siloxane intratubal devices (the Ovabloc method).
OBJECTIVE: To evaluate the importance of radiographs in women sterilized with hysteroscopically applied siloxane intratubal devices (ITDs). METHODS: A retrospective study of the frequency of abnormal radiographs in 500 women was carried out. The agreement in judging these radiographs and the expected reliability of the sterilization was measured. RESULTS: Abnormal radiographs were mostly documented in the first 100 sterilization procedures. Agreement in judging the radiographs is substantial. Different agreements on the expected reliability are due to the difference in experience with this sterilization method. CONCLUSIONS: Four types of abnormal radiographs can be categorized. Judgment of the radiographs can easily be learned. For the assessment of the reliability, training is necessary.
Female↗
Normal findings in vulvar examination and vulvoscopy.
OBJECTIVE: To determine the normal vulvar findings by naked eye examination and by vulvoscopy in healthy women without vulvar complaints. DESIGN: Observational study. POPULATION: Forty healthy volunteers without vulvar complaints recruited via a newspaper advertisement. METHODS: Vulvar examination, human papillomavirus (HPV) polymerase chain reaction of vulvar and cervical swabs, saline and KOH smears and vulvoscopy before and after the application of 5% acetic acid. MAIN OUTCOME MEASURES: Prevalence of vestibular erythema, vestibular papillomatosis, HPV infection on the vulva and in the cervix and vulvoscopic findings. RESULTS: The mean age of the women was 37.8 years (median 38.0, range 21-56). Nine women were current smokers and 21 had previously smoked. Naked eye vulvar examination showed vestibular papillomatosis in 13 women (33%) and vestibular erythema in 17 women (43%). The touch test was positive in 9 of the 17 women (53%) with vestibular erythema. Vulvoscopy after the application of acetic acid 5% showed an acetowhite vestibule in all women. Twelve women (30%) had acetowhite lesions outside the vestibule. Six women (15%) were positive for HPV DNA. The presence of HPV DNA did not correlate with vestibular erythema or vestibular papillomatosis. There was a weak association between HPV DNA and acetowhite lesions outside the vestibule (P = 0.055, Fisher's exact test). In this group the younger women significantly more often had vestibular papillomatosis (t-statistic = 3.07; P = 0.003) and women who smoke more often had a genital HPV infection (P = 0.016, Fisher's exact test). CONCLUSIONS: Vestibular erythema, vestibular papillomatosis, and acetowhite lesions are common in this group of healthy women without vulvar complaints.
Adult↗
Transvaginal interstitial laser treatment of the ovary for the management of chronic hyperandrogenic anovulation: first clinical experience.
The feasibility of ultrasound-guided transvaginal interstitial laser treatment of the ovary (TILT) and its efficacy for ovulation induction was investigated in 3 hormone-therapy-resistant patients with chronic hyperandrogenic anovulation. TILT was performed at powers of 1-2 W and exposures of 75-600 s. Clear-cut hyperechogenic zones developed during laser irradiation with diameters of up to 13.7 mm. Spontaneous ovulation and/or hormonal changes after TILT did not occur. No adhesion formation was seen during a laparoscopy or laparotomy in 2 patients 6 months after TILT. In conclusion, TILT of the ovaries was simple to perform but so far the clinical results are disappointing. Further studies with a modified technique are necessary to further investigate the efficacy of TILT.
Adult↗
Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding?
BACKGROUND: To determine the predictive value of dilatation and curettage (D&C) for diagnosing intrauterine disorders in patients with persistent abnormal uterine bleeding. METHODS: An observational descriptive study was performed in a large university-affiliated teaching hospital. The suspicion of intrauterine disorders described in theater-reports involving D&C was compared with the hysteroscopical findings in 131 premenopausal patients with persistent complaints of abnormal uterine bleeding who were referred by other gynecologists within six months after D&C. Pre-test probability (prevalence), post-test probabilities (predictive values) and likelihood-ratio's were calculated. RESULTS: The pre-test probability for all intrauterine disorders was 0.49. The post-test probabilities for a 'suspect' and a 'not suspect' D&C were 0.61 and 0.46 respectively with an overlap of confidence-intervals. The corresponding likelihood-ratio's were 1.69 and 0.87 respectively. CONCLUSIONS: D&C findings were of no value in the prediction of the presence or absence of intrauterine disorders in this population with persistent complaints.
Adolescent↗
Influence of diagnostic conization on surgical morbidity and survival in patients undergoing radical hysterectomy for stage IB and IIA cervical carcinoma.
The purpose of this retrospective study was to investigate whether diagnostic conization influenced surgical morbidity of a subsequent radical hysterectomy in patients with early cervical carcinoma. Furthermore, the impact of an irradical conization on nodal metastases and prognosis was analysed. Included were 271 patients with stage IB and IIA cervical carcinoma who underwent an Okabayashi radical hysterectomy between 1982 and 1991. There were 68 patients who underwent conization prior to radical hysterectomy. The conization-radical hysterectomy interval was approximately six weeks. Surgical morbidity in patients with a previous conization was not significantly different from that in patients without a previous conization. Survival was also not significantly different between these groups (95% vs. 91%, p = 0.23). Multivariate analysis showed that an irradical conization was not associated with an increased risk for nodal metastases or a poorer prognosis. We suggest that in early cervical carcinoma, a diagnostic conization does not adversely affect early morbidity of a following radical hysterectomy. An irradical conization does not seem to influence prognosis.
Adult↗
Human papillomavirus DNA after treatment of cervical dysplasia: low prevalence in normal cytologic smears.
BACKGROUND: The presence of human papillomavirus (HPV) DNA in relation to cervical cytology was evaluated after treatment of cervical dysplasia. METHODS: Forty patients, 22 with normal and 18 with abnormal cytology (mild or moderate dyskaryosis), with a history of cervical dysplasia were selected. Only patients with HPV DNA positive biopsies obtained before treatment were included. The presence of HPV was assessed in cervical smears at least 1 year after treatment of cervical dysplasia by using a polymerase chain reaction (PCR) with consensus primers (CPI/IIG). HPV typing was done by direct sequence analysis of the CPI/IIG PCR generated amplimers. RESULTS: Smears from 3 of the 22 patients with normal cytology after treatment were positive for HPV DNA (14%). HPV DNA positive smears were found in 13 of the 18 patients with abnormal cytology after treatment (72%) (relative risk: 5.3; 95% confidence interval: 1.78-15.75). In 11 of the 16 HPV DNA positive smears (69%), the HPV type was different from that before treatment. In 35 of 40 patients, the HPV type before treatment could not be detected after treatment (88%). CONCLUSIONS: A minority of the patients with normal cytology after treatment of cervical dysplasia had detectable HPV DNA. In contrast, a high prevalence of HPV DNA was found in cervical smears of patients with abnormal cytology after treatment of cervical dysplasia. After treatment, none of the patients with abnormal cytology but HPV DNA negative smears had recurrence of cervical intraepithelial neoplasia. This suggests the value of supplementary HPV DNA testing during follow-up of patients treated for cervical dysplasia.
Base Sequence↗
Interstitial laser treatment of the ovary: an experimental study in goats.
BACKGROUND AND OBJECTIVE: Interstitial laser treatment (ILT) of the ovary might be a new surgical approach to restore ovulation with a minimal risk of adhesion formation in patients with chronic hyperandrogenic anovulation who are unresponsive to hormone therapy. The objective was to investigate the feasibility of inducing a lesion limited to the center of the ovary in an animal model. STUDY DESIGN/MATERIALS AND METHODS: ILT was performed in seven goats using Nd:YAG laser in combination with ultrasound monitoring. The extent of direct thermal damage was investigated in two goats, treating both ovaries during a laparotomy at 2, 4, 6, and 8 W, respectively, for 5 min. Adhesion formation was evaluated in five goats 81 days after an unilateral laparoscopic ILT at 1, 2, 4, 6, or 8 W for 5 min. During treatment temperatures on the surface of the ovary were measured. RESULTS: Histology after 1 day showed sharply demarcated necrotic lesions located centrally or subcapsularly at low powers, whereas at higher powers the lesions extended to the surface of the ovary. At low powers no adhesions were observed, whereas higher powers resulted in periovarian adhesions. Temperatures measured on the ovarian surface during treatment ranged between 38 degrees C and 90 degrees C. Ultrasound monitoring of the extent of thermal damage failed due to poor positioning. CONCLUSION: Although this pilot study does not warrent firm conclusions, the results indicate that ILT of the ovary is feasible and that lesions without adhesions can be produced at low powers. The use of ultrasound to monitor the extent of thermal damage in the ovary should be a subject of further evaluation.
Aluminum Silicates↗
Office hysteroscopic tubal occlusion with siloxane intratubal devices (the Ovabloc method).
OBJECTIVES: To study the results of the Ovabloc method for female sterilization used in an outpatient setting. METHODS: A prospective longitudinal study at the Schieland Hospital of 411 patients who consented for the method for sterilization. For statistical analyses the x2 test is used for detection of differences between groups of patients. The life-table analysis is used for events during the follow-up period. RESULTS: Our results reflect those done under strict clinical conditions. The majority of the events took place in the first 36 months on Ovabloc. Unplanned pregnancies were mainly due to misdiagnosis in X-ray images and to incomplete procedures. CONCLUSIONS: The method failures are 3/1000 women in 12 months and 8/1000 women in 36 months. The follow-up should be extended to 12 months. The reversibility of the method remains questionable. The method should be offered to women with (relative) contraindications for laparoscopic sterilization such as severe obesity, extensive pelvic adhesions or anesthetic risks.
Adult↗
Transvaginal interstitial laser treatment of the ovary: a feasibility study in cows.
In 12 cows, transvaginal interstitial laser treatment (TILT) of the ovaries was performed using a neodynium:yttrium aluminium-garnet laser to investigate the feasibility of a new treatment approach for clomiphene-resistant patients with chronic hyperandrogenic anovulation. Powers of 1 and 2 W during 5 min of exposure were used. Sonographic changes of thermal damage during TILT, the extent and healing of the lesions by light microscopy and ultrasound during 3 month follow-up and adhesion formation were studied. During laser irradiation, a hyperechogenic zone developed around the fibre tip, with a mean +/- SD diameter of 4.4 +/- 2.0 mm at 1 W and 6.9 +/- 1.5 mm at 2. W. The mean diameters of the histological lesions 2 days after treatment were 7.3 +/- 2.5 mm at 1 W and 13.0 +/- 2.1 mm at 2 W. During follow-up, the mean diameter of both the histologically and the sonographically assessed lesions decreased, although transvaginal sonography (TVS) systematically and significantly underestimated the thermal damage. Lesions healed by fibrosis and no adhesions were present. TILT of the ovaries in cows is easy to perform and produces central or subcapsular necrosis without adhesions. TVS gives an indication of thermal damage but underestimates the extent of tissue damage in cow ovaries. Obviously, this study does not allow conclusions to be drawn concerning its safety and efficacy in man.
Animals↗
[Treatment of patients with trophoblastic tumors in the Academic Medical Center: 31 patients in 10 years, 1983-1992].
OBJECTIVE: Evaluation of the treatment of patients with gestational trophoblastic disease. SETTING: Academic Medical Centre, Amsterdam. DESIGN: Descriptive. METHOD: Clinical data from all patients treated between 1983 and 1992 were collected. RESULTS: Thirty-one patients were treated in this period. Eighteen patients had persistent trophoblast after a molar pregnancy, 7 had choriocarcinoma after a normal pregnancy and in 6 patients the obstetrical history was unclear. The initial treatment strategy was chosen on the basis of prognostic factors; low-risk patients received mono-chemotherapy (Methotrexate) and high-risk patients were treated with polychemotherapy (EMA/CO). In 15 cases adjuvant therapy was necessary. Complete remission was achieved in 29 patients, 2 patients died. The adverse effects of the chemotherapy were generally mild. CONCLUSION: Persistent trophoblastic disease has an unpredictable presentation and course. Therefore treatment should preferably be given in a reference centre.
Adult↗
Multifocal vulvar intraepithelial neoplasia grade III and multicentric lower genital tract neoplasia is associated with transcriptionally active human papillomavirus.
BACKGROUND: The incidence of vulvar intraepithelial neoplasia Grade III (VIN III) is increasing and is diagnosed at a younger age than previously. VIN III is often multifocal and frequently coexists with multicentric dysplastic lesions in the cervix and vagina. Warty-type VIN III more often has been found to contain human papillomavirus (HPV) DNA than basaloid-type VIN III: The authors performed HPV DNA polymerase chain reaction (PCR) analysis in 48 VIN III biopsies and reverse transcriptase (RT)-PCR in 8 HPV-16 DNA-positive multifocal VIN III biopsies to detect E6/E7 transcripts. METHODS: Human papillomavirus DNA detection and histologic analysis were performed on alternating slides of paraffin embedded biopsies. Polymerase chain reaction was performed with consensus primers, and HPV typing was performed by direct sequencing. Total RNA was isolated from frozen biopsies by centrifuging a guanidinium thiocyanate (GTC) lysate through a cesium chloride (CsCl) cushion. The RT reaction was performed using a 3' primer, located just downstream of the E7 stop codon, and the PCR reaction was performed using the same 3' primer and a 5' primer located just downstream of the E6 start codon. RESULTS: The mean age of the 48 patients was 37.7 years. Eighty-one percent had multifocal VIN III: Sixty-six percent had multicentric neoplasia. Forty-six percent of the biopsies were warty-type, 17% basaloid-type, 35% mixed-type and 2% differentiated-type. Ninety-two percent were HPV-positive and 83% contained HPV-16 DNA. Human papillomavirus DNA was more often present in multifocal VIN III lesions than in unifocal VIN III lesions and also more often in VIN III lesions coexisting with other dysplastic multicentric lesions than in unicentric VIN III lesions. Warty-type VIN III more often contained koilocytes than basaloid-type VIN III: A correlation between different morphologic forms of VIN III and the presence of HPV DNA was not found. Both types of VIN III often coexist in one lesion. In all the RT-PCRs, a 593-base-pair fragment was detected, corresponding to the expected length of the major E6*-E7 mRNA. CONCLUSIONS: The observed high prevalence of transcriptionally active HPV DNA associated with multifocal and multicentric dysplasia suggests a role of HPV in the pathogenesis of these lesions. A positive correlation between different morphologic forms of VIN III and the presence of HPV DNA was not found.
Adult↗