Biomedical subjects
F Girardi
Publications and source records attributed to F Girardi.
[Precancerous stages of cervix cancer (CIN)--attitude and coping with the disease].
The subjective reactions and the mental state of 50 patients with a diagnosis CIN I, II and III were studied. The data were gathered after gynaecological follow-up examinations in semistructured interviews and with a list of complaints (B-L) according to Zerssen (1975). Patients with CIN I or II were examined and interviewed 3 months after diagnosis, patients with persistent CIN I or II were studied after 6 months, and patients with CIN III before conization. Patients with CIN reacted to the diagnosis in a similar manner to patients confronted with the diagnosis of cancer. Effective coping with the disease depended on adequate medical information being received by the women. The patients who were satisfied with the medical information had a more positive approach to the course of the disease and found it less life-threatening than those patients who were dissatisfied with the information received. The results of this study indicate that subjective experience of the disease is largely independent of its objective severity.
Microinvasive carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics Stage IA).
In 1985 the International Federation of Gynecology and Obstetrics (FIGO) subdivided Stage IA cervical cancer and specified metric criteria to demarcate Stage IA from Stage IB. Early stromal invasion (Stage IA1) denotes the first invasive protrusions of a carcinoma in situ into the stroma. Microcarcinomas (Stage IA2) are small cancers a number of orders of magnitude larger than Stage IA1 lesions and with a maximum depth of invasion of 5 mm and a maximum horizontal spread of 7 mm; larger lesions are classified as Stage IB. This study reviews 486 patients previously classified as having Stage IA disease. This yielded 344 Stage IA1 and 101 Stage IA2 lesions; 41 cancers were reclassified as Stage IB. Three hundred nine, 89, and 38 patients were followed for greater than or equal to 5 years. One (0.3%) patient with Stage IA1 disease re-presented with Stage IIB disease 12 years after conization. Five (5.6%) patients with Stage IA2 lesions developed invasive recurrences; three died. None of the 38 patients reclassified as having a Stage IB lesion, including 16 who were treated conservatively, developed a recurrence. The FIGO classification is not a guideline for treatment. Stage IA1 lesions can be treated conservatively, but treatment in Stage IA2 must be individualized. Risk factors such as vascular space involvement and confluency are of high sensitivity but low specificity.
Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer.
One hundred eighty patients with ovarian cancer underwent complete pelvic lymphadenectomy (n = 75) or pelvic and paraaortic lymphadenectomy (n = 105). Twenty-one patients underwent a preoperative biopsy of the scalene lymph nodes. The incidence of positive lymph nodes was 24% in stage I (n = 37), 50% in stage II (n = 14), 74% in stage III (n = 114), and 73% in stage IV (n = 15). Of the 105 patients who underwent pelvic and paraaortic lymphadenectomy, 13 (12%) had positive pelvic and negative paraaortic nodes and 10 (9%) had positive paraaortic and negative pelvic nodes. Positive scalene nodes were found in four patients (19%) later shown to have stage IV disease. One hundred forty patients were studied for number of involved nodes and node groups, size of nodal metastases, residual tumor, and survival. Of the 81 patients with positive nodes, most had only one or two positive node groups or one to three positive individual nodes. A few patients had seven to eight involved node groups with up to 44 positive nodes. Greater numbers of positive nodes were found in stage III than stage IV. The size of the largest nodal metastasis was not related to the clinical stage or survival, but did correlate with the number of positive nodes. Stage III patients with no residual tumor had a significantly lower rate of lymph node involvement than those with tumor residual (P less than 0.01). Actuarial 5-year survival rates of patients with stage III disease and no, one, or more than one positive nodes were 69, 58, and 28%, respectively.
[The support pessary--a therapeutic possibility in premature opening of the uterine cervix].
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[Cervix cancers in young women].
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[Lymph node status in corpus and cervix cancer].
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Anti-contamination primers to improve specificity of polymerase chain reaction in human papillomavirus screening.
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Cell differentiation-related gene expression of human papillomavirus 33.
The gene expression of human papillomavirus (HPV) 33, which can be detected both in benign and malignant genital tumors, was analyzed in a cervical condyloma acuminatum by in situ hybridization using open reading frame-specific RNA probes. Viral mRNA concentrations increased with the degree of differentiation of the keratinocytes. The probes for reading frames E4 and E5 generated the most intense signals. The patterns of the specific viral mRNAs were very similar to those in condylomas induced by HPV 6 or 11, which are only rarely associated with malignancies. This implies that in tumors of the same degree of morphological differentiation the gene expression program of different HPV types is essentially identical. The pattern observed here most likely corresponds to a productive phase of viral infection.
[Diagnosis and therapy of small cervix cancer].
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Human papillomavirus 16 DNA in cervical cancers and in lymph nodes of cervical cancer patients: a diagnostic marker for early metastases?
Human papillomavirus (HPV) 16 is most prevalent in cervical cancers and also persists in metastases. We examined HPV16-DNA-positive primary cancers and several lymph nodes from each of 14 patients to evaluate the use of HPV16 DNA as a diagnostic marker for the detection of early node involvement. The HPV16 DNA was exclusively integrated in 39% of the primary cancers, predominantly episomal in 36%, and integrated and extrachromosomal to a similar extent in 25%. Thirteen of 16 involved lymph nodes contained HPV16 sequences. Integrated viral DNA showed the same pattern in primary tumors and in metastases. The level of extrachromosomal HPV16 DNA, however, appeared to be considerably reduced in some nodes. HPV16 DNA was also detected in 18 out of 59 histologically negative lymph nodes. This result recommends nucleic acid hybridization as a sensitive method for the detection of HPV-DNA-positive cancer cells. The prognostic significance of viral sequences in histologically negative nodes remains to be established.
The importance of parametrial lymph nodes in the treatment of cervical cancer.
This study aimed to determine the presence, distribution, and metastatic involvement of lymph nodes in the parametria of patients undergoing radical hysterectomy for cervical cancer. Parametrial nodes were present in the giant sections of 280 (78%) of 359 surgical specimens, and metastatically involved nodes were found in 63 (22.5%) of these 280. Both positive and negative nodes were distributed through the entire parametrium. The frequency of positive nodes was linearly associated with both the clinical stage and with the tumor volume. The recurrence rate was higher when the parametrial nodes were positive than when they were negative. Survival dropped when the parametrial nodes were positive, regardless of the clinical stage.
The spread of ovarian cancer.
Spreading intra-abdominally, ovarian cancer reaches the upper abdomen relatively quickly. Metastases result from the implantation of cells from the primary tumour or, perhaps, may arise de novo from the peritoneal epithelium. The tumour also spreads via the lymphatics directly to the pelvic nodes, directly to the para-aortic nodes, or directly to both. Pelvic nodes were positive in 57.9% of patients of all stages. The highest incidence, 70.4%, was found in Stage III. The percentage of positive para-aortic nodes was lower, namely 50.9% overall incidence and 67.6% in Stage III. Concerning the concomitant involvement of pelvic and para-aortic nodes, 40.4% of patients with positive pelvic nodes also had positive para-aortic nodes. Of patients with negative pelvic nodes, 36.8% also had negative para-aortic nodes. Of all patients, 12.3% had positive pelvic nodes and negative para-aortic nodes. Conversely, 10.5% of all patients had positive para-aortic nodes and negative pelvic nodes. There is a significant association between the involvement of the diaphragm and that of the pelvic and para-aortic nodes. Of those patients with tumour deposits on the diaphragm, 84.4% also had positive retroperitoneal nodes. Conversely, 55.9% of patients with positive nodes also had tumour deposits on the diaphragm. This means that ovarian cancer spreads almost simultaneously in two ways: intra-abdominally and retroperitoneally. Surgical treatment must address both modes.
[Clinical significance of human papillomavirus infection].
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[Microbiologic findings including Chlamydia serology in cervix dysplasia and human papillomavirus infection].
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[Clinical significance of HPV infection for cervix cancer].
536 cervical biopsies with various benign and malignant epithelial changes were studied histologically and virologically with Southern Blot hybridization. In 51 cases of normal squamous epithelium HPV 16 DNA was found in four (8%) and HPV 6/11 DNA in one (2%). In 136 cases of benign acanthotic epithelium HPV 16 DNA was found in 14 (10%), HPV 6/11 DNA in six (4%), and HPV 18 DNA in two (2%). During a follow-up of four years none of these patients developed CIN. 339 further stemmed from epithelium with various degrees of CIN and squamous cell cancers. HPV 6/11 was found most often (12%) in CIN I, while in carcinomas it was found only in combination with HPV 16. In contrast, HPV 16 was found most often (43%) in invasive cancers and less often in CIN (12%). 22 CIN-I cases were available for follow-up; 18 showed regression and 4 persistency. From the 65 patients with CIN II 24 have regressed, 41 were treated by cone biopsy because of persistency. 20 of these cases harboured HPV 16/18 DNA and in two cases HPV 6/11 was found. 84 invasive cases were studied virologically. 43 patients underwent radical abdominal hysterectomy with complete pelvic and paraaortic lymphadenectomy. The surgical specimens were processed in giant sections and studied morphometrically. HPV-16-positive tumours significantly more often spread to parametrial and pelvic lymph nodes then did HPV-negative tumours. In addition the pelvic lymph nodes of 40 invasive cases were studied virologically. HPV 16 DNA was not only found in lymph node metastases of HPV-16-positive tumours, but also in lymph nodes free of metastatic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Human papillomavirus DNA in normal, metaplastic, preneoplastic and neoplastic epithelia of the cervix uteri.
Colposcopically directed cervical punch biopsies from 362 patients were screened by Southern blot hybridization for the presence of DNA of human papillomavirus (HPV) 6, 10, 11, 16, 18, 31 and 33. The biopsies represented original squamous epithelium, epithelium of metaplastic origin, different stages of cervical intraepithelial neoplasia (CIN) and invasive carcinomas. HPV6/11, 16, 18 and 31 were detected in 2.9% to 13.7% of histologically normal epithelia. HPV6/11 prevailed in CIN I. HPV16 was clearly more abundant than other HPV types in high-grade CIN and invasive cancers (50%-60%), compared with healthy epithelium. Restriction enzyme cleavage analysis of DNA from primary cancers and corresponding metastases proved the stable association of HPV16 DNA with invasive tumor cells. Preliminary follow-up studies of CIN II patients suggested that HPV16-associated lesions are relatively more likely to persist or to progress. Taken together, the data support the notion of a higher oncogenic potential of HPV16.
The significance of the parametrium in the operative treatment of cervical cancer.
The first sharp improvement in the operative treatment of cervical cancer was the shifting of the plane of resection away from the tumour into the parametria. This permitted resection of the primary cancer with a margin of healthy tissue. Systematic studies of excised parametrial tissue, carried out around the turn of the century, showed four types of parametrial involvement: continuous, discontinuous, carcinomatosis of the parametrial lymphatics, and parametrial lymph node involvement. It is well known that histologically demonstrated parametrial involvement often contradicts the clinical stage. So-called staging laparotomies are meant to address this problem but they, too, are inadequate since most parametrial cancer deposits are microscopic and cannot be palpated. In our own studies of totally extirpated parametria, contiguous cancer spread into the parametria never exceeded 10 mm, not even in the largest still-operable tumours. Thus the theory of contiguous, direct cancer spread to the pelvic wall is wrong. Parametrial involvement usually occurred as cancer deposits in the rarely mentioned parametrial lymph nodes. Parametrial involvement correlates better with the size of the primary tumour, expressed as the tumour-cervix quotient, than with the clinical stage. The smallest tumours, without showing continuous parametrial involvement, had a 3.4% incidence of positive nodes. Thirty-five per cent of the patients with the largest tumours had positive parametrial nodes. Parametrial lymph nodes were found in 280 (78%) of 359 surgical specimens processed as giant sections. Sixty-three patients (22.5%) had positive parametrial nodes. The nodes at the pelvic wall were involved in 80% of the patients with positive parametrial nodes. The five-year survival rate was 84% if the parametria were free of disease, but it dropped to 53% with any type of parametrial involvement. Survival rates did not differ much if only the parametrial nodes or only the pelvic nodes were positive (56% and 66%, respectively). However, if both groups were positive survival dropped to 43.1%. Positive parametrial nodes can be located anywhere in the parametrium; therefore, surgery must remove the entire structure. It remains to be seen whether an exception can be made for small Stage Ib tumours, or if lymphadenectomy can be omitted in these patients. If so, radical vaginal surgery may be the treatment of choice.