Biomedical subjects
Publications and source records attributed to I R Horowitz.
A squamous cell carcinoma of the cervix metastatic to the skin at the site of a previous retroperitoneal drain is detailed. A review of the literature concerning skin metastases in cervical cancer is also presented. This is the only case the authors can find in the literature of squamous carcinoma of cervix metastasizing to a drain site.
A case of metastatic adenocarcinoma of the endometrium following endometrial ablation is described. A discussion of the development and evolution of endometrial ablation procedures is presented. Recommendations for patient selection and postablation surveillance are suggested. The authors believe this case report to be the third described in the literature. (Background. A case of endometrial adenocarcinoma developing after transcervical endometrial ablation with a resectoscope was recently reported (A. B. Copperman, A. H. DeCherney, and D. L. Olive, Obstet. Gynecol. 82, 640-642 (1993)). It is recognized that functional residual islands of endometrial tissue remain in both symptomatic and asymptomatic patients following ablation. There is only limited experience using endometrial ablation in postmenopausal patients and in others at high risk for endometrial cancer. Case. A patient presented who developed metastatic adenocarcinoma of the endometrium after endometrial ablation for postmenopausal bleeding. Conclusion. With endometrial ablation procedures, the potential exists for missed areas or buried nests of functional endometrial tissue that may later undergo malignant transformation or have already become metaplastic and invaded the myometrium. Therefore, close postoperative surveillance, including thorough evaluation of postoperative bleeding, is indicated. Further studies with long-term follow-up are needed in order to define the safety and efficacy of endometrial ablation in the high-risk patient.
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To determine if human papillomavirus (HPV) in the primary tumor was associated with disease-free survival of stage Ib cervical cancer patients, archival tissues from 47 patients were analyzed for HPV DNA by in situ hybridization (ISH) and polymerase chain reaction. HPV integration was determined by ISH signal pattern. Laboratory data were correlated with clinical parameters and disease-free survival. Kaplan-Meier estimates of 4-year disease-free survival were 56% in women with HPV detected in the primary tumor by ISH and 100% for women in whom HPV was not detected (P = .02). Four-year disease-free survival was 39% for patients with integrated HPV in the primary tumor (P = .005 vs. HPV-negative tumors and .05 vs. HPV episomal or episomal/integrated). HPV detection and integration state was not associated with any other clinical variable. Detection of integrated HPV DNA in the primary tumor was strongly associated with treatment failure.
We report a case of basal cell carcinoma arising in a previously radiated field after treatment of cervical cancer. Our search of the literature yielded no other case of basal cell carcinoma due to irradiation for cervical carcinoma.
Sex cord stromal tumors of the ovary can be characterized by the production of virilizing steroid hormones. The authors present a case of a poorly differentiated Sertoli-Leydig cell tumor in which ascitic fluid was found to have a high concentration of androgenic hormones and precursors from the delta steroid pathway (17-OH progesterone, testosterone, and androstenedione). These values correlated with samples taken from the right ovarian vein, draining the ovarian neoplasm, but not with those taken from the left ovarian vein or the peripheral blood sample. Selective peritoneal fluid sampling may aid in the diagnosis of hormonally active tumors.
Eight patients with benign obstetric and gynecologic conditions required embolization. There was a total of 11 embolizations, and embolizing agents were chosen depending on the abnormality requiring embolization. Gelfoam, Ivalon and alcohol were used to treat vascular malformations. Ovarian veins were embolized with coils. Postoperative bleeding was managed with Gelfoam, coils and/or Ivalon. Four patients had bleeding after hysterectomy or vaginal suspension. One patient had postdelivery bleeding. All the bleeding was controlled after embolization. A uterine arteriovenous malformation was managed with embolization, allowing the patient to carry her next pregnancy to term. The symptoms of a vulvar hemangioma and ovarian syndrome were controlled with vascular embolization. Morbidity was minimal. Embolization is the primary treatment of choice in obstetric and gynecologic patients with postoperative bleeding or symptomatic vascular malformation.
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The patient presented had primary tumors of the ovary and colon in association with pseudomyxoma peritonei. Since pseudomyxoma peritonei has been associated with mucin-producing tumor of the genital and gastrointestinal tract, a thorough evaluation of the gastrointestinal tract should be performed in patients thought to have pseudomyxoma peritonei secondary to an ovarian neoplasm.
Medical students throughout the world learn clinical skills in a physical diagnosis course. Clinicians can use this approach to design a focus review to serve as a method of evaluation in the quality assurance of healthcare and as a research tool.
Three hundred thirty-three patients who presented with cervical carcinoma from November 1980 through June 1985 were compared for potential factors associated with histology. Sixteen percent of all patients presenting with cervical carcinoma during this 5-year period had an adenocarcinomatous histology. Emphasis was placed on demographic and socioeconomic factors. The histologic distribution was the following: epidermoid carcinoma 279, adenocarcinoma 28, and adenoepidermoid carcinoma 26. The latter two histologies were not different for any factors and therefore combined for statistical comparison with epidermoid carcinoma. When epidermoid (E) carcinoma of the cervix was compared with the histologies having an adenocarcinomatous component (A), the following demographic and socioeconomic factors were statistically, different (P less than 0.05): Unemployment (E 69% vs. A 46%) P less than 0.002; Income less than $6000/yr (E 48% vs. A 26%) P less than 0.005; Less than a 12th-grade education (E 85% vs. A 72%) P less than 0.05; Smokers (E 67% vs. A 40%) P less than 0.001; First coital experience less than 18 years (E 58% vs. A 39%) P less than 0.05. Age, parity, and number of sexual partners were not significantly different between the epidermoid and adenocarcinoma groups. The number of patients with stages II, III, and IV was too small to provide a meaningful statistical comparison of survival for the two histologies. Our data suggest that epidermoid and adenocarcinoma of the cervix may represent diseases with distinct populations at risk.
The effects on intestinal transport of either a semipurified preparation of enterotoxin elaborated by Klebsiella pneumoniae or similaryly prepared control material were tested by marker perfusion studies in the small intestine of rats. At a concentration of 2 mg/ml, the enterotoxin produced net secretion of water, Na, and Cl in both jejunal and ileal segments; HCO3 transport was not affected. Net secretion was evident within 30 min after intorduction of the toxin and was maximal after 90 min. The addition of 56 mM glucose to the enterotoxin-containing perfusion fluid resulted in reversal of water and Na transport to net absorption in both intestinal segments. The enterotoxin also produced a significant depression of xylose absorption in both the jejunum and ileum but did not affect the absorption of either glucose or L-leucine. Intestinal structure was not altered after perfusion of the toxin but insillation of approximately one-quarter of the total perfusion dose into a ligated jejunal loop for 18 h produced fluid secretion and structural abnormalities. These observations confirm the fact that other species of coliform bacteria in addition to tescherichia coli are capable of elaborating an enterotoxin. Such species commonly contaminate the small intestine of persons with tropical sprue and it is suggested that chronic exposure of the intestinal mucosa to the enterotoxin elaborated by these bacteria may be a factor in the pathogenesis of intestinal abnormalities in thid disorder.
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Glycodelin, an immunosuppressive protein with contraceptive properties, is synthesized by a variety of tissues and cell types. The ability of reproductive tissues to synthesize glycodelin is of major interest in pregnancy and disease conditions. We studied glycodelin levels in subjects with malignant gynecological tumors and in control subjects. Using a polyclonal glycodelin antibody against the synthetic glycodelin peptide sequence, an enzyme-linked immunosorbent assay (ELISA) was devised to measure plasma glycodelin levels. The assay detected as much as 5 ng/ml of glycodelin. There was a significant increase in plasma glycodelin levels in endometrial > ovarian > cervical cancer subjects when compared to those of controls. Strong expression of mRNA and protein were found in the ovarian and endometrial tumor tissues. Given glycodelin's immunosuppressive abilities, increased level of glycodelin may facilitate tumor growth in gynecological malignancies.