Biomedical subjects

L D Roman

Publications and source records attributed to L D Roman.

At least 37 records · Page 2Linked to original sources

PubMed1997

[The quality of medical care given to patients with esophageal cancer in St. Petersburg and the Leningrad region].

The data on the morbidity, time of diagnosis and results of treatment of esophageal cancer in St. Petersburg and Leningrad Region (1992-1994) were analyzed. The morbidity rates were higher in women than in men, the predominant age being over 60. Morphological verification data were not available in almost half the cases. Stage I-II tumors were detected in 15.7-26.5%. Specialized treatment was given to 25%, combination one-to nearly 2%. To raise the standards of medical aid, it is suggested that measures be taken to ensure stable operation of the Cancer Register, St. Petersburg, and to offer treatment to esophageal cancer patients at specialized medical facilities.

Age Distribution↗

PubMed1997

[Ultrasonic diagnosis of nodal lesions of the axillary-jugular lymphatic plexus and their evolution].

Axillary lymph nodes of three levels may be adequately differentiated on the basis of the TNM classification by application of layer-by-layer tomographic examination of axillary fossa and thoracic and clavicular-thoracic triangles in the axillary cavity. Echographs show musculus thoracis minor as a distinct point of reference. Topographic features of deep lateral cervical lymph nodes may be used in anatomical identification of internal jugular nodes, transverse cervical artery, accessory nerve and suprajugular lymph nodes. In cases of multiple involvement of lymph nodes, their shape (chain or cluster) may be identified. It can be shown Whether lymph flows are in series, collateral centripetal, collateral centrifugal (recirculatory) or run parallel in metastatic areas. Varying patterns of lymph flow through collateral pathways formed in the axillary-jugular lymph plexus are responsible for the variety of patterns of lesion clusters in the lymph nodes system.

Axilla↗

PubMed1997

[Successful surgical treatment of cancer with multiple location].

The lecture deals with the specific characteristics of cell membrane damage caused by in vivo and in vitro irradiation at the dosage commonly used in radiation therapy of malignant tumors. The mechanisms of lymphoid cell loss to ionizing radiation are described. They include metabolic depletion, direct damage to the cell membrane causing loss of its asymmetry and surface receptors expression being altered.

Adenocarcinoma↗

PubMed1996

Residual disease in the uterus after preoperative radiotherapy and hysterectomy in stage IB cervical carcinoma.

Sixty-one patients with FIGO IB cervical cancer treated with planned preoperative radiotherapy (dose to point A: 52-93 Gy, mean 73 Gy) and hysterectomy from 1969 to 1993 were retrospectively reviewed. Patient characteristics and treatment parameters and their association with residual tumor in the hysterectomy specimen were analyzed. Glandular (adenocarcinoma and adenosquamous) tumors were smaller than squamous tumors: 6/11 (55%) were < 6 cm in diameter, versus 12/50 (24%) squamous tumors (p = 0.03). Glandular tumors had a higher incidence of residual disease: 10/11 (91%) versus 24/50 (48%) (p = 0.01). There was no association between presence of pathologic residual disease in the hysterectomy specimen and tumor size, morphology (endophytic vs. exophytic), patient age, dose to point A, time to deliver radiotherapy, or interval between radiotherapy and hysterectomy. Overall 34/61 (56%) patients had residual disease in their hysterectomy specimens after planned preoperative radiotherapy. There were significantly more glandular tumors than squamous tumors with residual disease, even though glandular tumors were a group of smaller tumors.

Adenocarcinoma↗

PubMed1996

[Variants in the definitive organization of the lumbar lymph-conducting pathways in the applied aspect].

Topographic-anatomical investigations gave grounds for the description of 4 stages of the development of the posterior parietal bed of the abdominal cavity. On the basis of the embryo-anatomical systematization three morpho-topographic types of the lumbo-lymphatic pathways were established: right-sided (20%), left-sided (20%) and uniform (60%) types, each of them playing a certain part in metastasizing. Embryo-anatomical grounds are given for operative accesses to the superficial group of the right and left lumbar lymphatic pathways.

Fetus↗

PubMed1995

The role of endocervical curettage at cervical conization for high-grade dysplasia.

OBJECTIVE: To quantify the risk of invasive cancer above the location where the conization specimen was taken in patients with an endocervical curettage (ECC) positive for dysplasia at conization for high-grade cervical intraepithelial neoplasia (CIN), and to determine if any pathologic features may influence this risk. METHODS: The charts of 104 patients who underwent cervical conization for high-grade dysplasia followed by repeat conization or hysterectomy at Los Angeles County + University of Southern California Women's Hospital between January 1986 and December 1992 were reviewed retrospectively. Patients with invasive cancer or glandular dysplasia on the initial conization were excluded. The ECC performed immediately after conization biopsy (conization ECC) was benign in 63 patients and contained dysplasia in 41. All available conization ECC specimens that contained dysplasia were evaluated for volume of dysplasia and degree of cytologic atypia. Fisher exact test was used for statistical comparison between and within groups. RESULTS: Invasive cancer was not present in any patients in the benign ECC group but was present in nine (22%) patients in the dysplasia group (P < .0001); five of these patients had microinvasion (no more than 3 mm of stromal invasion and no lymph-vascular space involvement) and four had frank invasion. Comparison of patients with involved endocervical margins revealed that none of 37 patients in the benign ECC group versus eight of 27 patients in the dysplasia group had invasive cancer (P < .0005). All patients with invasion were 35 years or older and all patients with frank invasion were 50 years or older. Neither volume nor cytologic grade of dysplasia in the ECC was predictive of invasion in the residual cervix. CONCLUSIONS: An ECC at conization positive for dysplasia is an important predictor of invasion in the residual cervix of patients whose conization reveals high-grade intraepithelial neoplasia and should be routinely performed. Women 50 years or older with both a positive endocervical margin and conization ECC should undergo repeat conization before further therapy. Women under 50 years of age should undergo repeat conization if fertility is not desired; otherwise, close follow-up is necessary to exclude the presence of an invasive lesion in the residual cervix.

Adult↗

PubMed1995

Preliminary analysis of the behavior of stage I ovarian serous tumors of low malignant potential: a Gynecologic Oncology Group study.

PURPOSE: From December 1983 through February 1992, a prospective study designed to determine the clinical course of patients with ovarian tumors of low malignant potential (LMP) was conducted by the Gynecologic Oncology Group (GOG). MATERIALS AND METHODS: This protocol was developed to evaluate the following (1) the biologic behavior of ovarian LMP tumors, (2) the effectiveness of melphalan chemotherapy in patients with clinically detectable residual disease after surgical staging and in patients whose tumors progress or recur after surgical therapy, and (3) the response rate to cisplatin in those who failed to respond to melphalan therapy. The study group consisted of 146 assessable patients with stage I serous LMP tumors. All of these women had the affected ovary (or ovaries) removed, and a complete staging operation was performed in each case. While 123 patients had a total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), 21 retained the uterus and one normal-appearing ovary and fallopian tube. No adjuvant chemotherapy or radiation therapy was administered to any patients in the stage I study group. RESULTS: The median follow-up time was 42.4 months (range, 1.6 to 108). Thus far, no patient with a stage I ovarian serous LMP tumor has developed recurrent disease. CONCLUSION: Stage I ovarian serous LMP tumors rarely, if ever, recur. Limited resection, after meticulous surgical exploration, is adequate therapy for women of reproductive age.

Adult↗

PubMed1995

Differentiation of benign and malignant adnexal masses: relative value of gray-scale, color Doppler, and spectral Doppler sonography.

OBJECTIVE: The purpose of this study was to evaluate prospectively the relative usefulness of color Doppler, spectral Doppler, and gray-scale sonography in differentiating benign from malignant adnexal masses. SUBJECTS AND METHODS: A total of 170 adnexal masses in 161 patients were classified prospectively as suggestive of or not suggestive of malignant tumor on the basis of gray-scale morphology, internal flow versus peripheral or no flow, and spectral Doppler pulsatility, as measured by a pulsatility index (PI) threshold of 1.0 and a resistive index (RI) threshold of 0.4. RESULTS: Surgical pathology revealed 123 benign masses and 46 malignant masses. One malignant mass was confirmed by cytologic evaluation of ascitic fluid. On gray-scale analysis, 46 of the 47 malignant masses were classified as suggestive of tumor, and 76 of the 123 benign masses were classified as not suggestive of tumor (sensitivity, 98%; specificity, 62%; negative predictive value [NPV], 99%; and positive predictive value [PPV], 50%). The use of internal color flow as a predictor of malignant tumor yielded a sensitivity of 77%, a specificity of 69%, an NPV of 89%, and a PPV of 49%. The PI and RI values were significantly lower (p < .0001) in malignant masses than in benign masses, although the values overlapped considerably. For a PI of less than 1.0, sensitivity was 67%, specificity was 66%, NPV was 83%, and PPV was 46%. For an RI of less than 0.4, sensitivity was 24%, specificity was 90%, NPV was 73%, and PPV was 50%. CONCLUSION: In our series, a gray-scale prediction of benignity was reliable (NPV = 99%), and a prediction of malignancy was unreliable (PPV = 50%). Internal color flow was not useful as a predictor of malignancy (PPV = 49%). Although the absence of internal or peripheral color flow suggested benignity (NPV = 94%), only 17 (16 benign) of the masses (about 10%) had no flow. Spectral Doppler analysis with RI and PI was not useful, as no reliable discriminatory value with both high sensitivity and high specificity could be found for either parameter because of the overlap in values obtained for benign and malignant masses.

Adnexal Diseases↗

PubMed1994

Death from anaphylaxis to cisplatin: a case report.

A patient with a history of ovarian carcinoma that had responded well to cisplatin was treated with platinum agents for a recurrence. She had a seizure while receiving carboplatin and was switched to cisplatin. The patient was premedicated with antihistamines and steroids. After approximately 400 micrograms of cisplatin she went into anaphylactic shock and could not be resuscitated. The reported frequency of hypersensitivity reactions to cisplatin is between 1 and 20%. Premedication with steroids and antihistamines, single-agent chemotherapy, and slow rate of infusion are of help in preventing these reactions. All of these precautions were unsuccessful in preventing refractory anaphylaxis in this patient.

Anaphylaxis↗

PubMed1994

The significance of positive margins in loop electrosurgical cone biopsies.

OBJECTIVE: To determine the interpretability and significance of the endocervical margins of cervical cone biopsy specimens removed by the loop electrosurgical excision procedure (LEEP). METHODS: Loop electrosurgical cervical conization was performed on 57 women with biopsy-confirmed, high-grade dysplasias in whom the extent of the lesion could not be determined by colposcopic visualization. Internal endocervical margins of the resected specimens were marked with ink by the operating physician and evaluated microscopically by the pathologist. Endocervical curettage (ECC) was done in all instances, and all subjects were followed for 1 year after the procedure. RESULTS: Histologic evaluation of the inked endocervical margins was possible for all 57 resected specimens and was in no instance hindered by thermal artifact. In 19 patients, dysplasia was present in the inked core margin, the ECC, or both. Each patient had re-excisions of the endocervical area; 12 of the 19 (63%) had dysplasia in the specimen. Of 12 cases in which dysplasia was present in both the endocervical margin and the ECC, nine had residual dysplasia. Two of four patients with positive margins but a negative ECC had residual dysplasia, but only one of three patients with a negative endocervical margin and a positive ECC showed residual dysplasia. In the 38 patients with negative inked margins and a negative ECC, there was only one instance of dysplasia demonstrated during the 1-year follow-up period. CONCLUSION: Endocervical margins of cone biopsies removed by LEEP can be accurately assessed pathologically and can help predict the presence of persistent dysplasia.

Adult↗

PubMed1993

Dedifferentiated extrauterine adenosarcoma responsive to chemotherapy.

Extrauterine adenosarcoma, a low-grade mixed mesodermal tumor, is an uncommon neoplasm. Little information is available regarding the efficacy of treatment of tumors not amenable to surgical resection. Our patient's pelvic adenosarcoma progressed despite multiple attempts at surgical excision over an 8-year period. Hormonal therapy with medroxyprogesterone acetate and tamoxifen did not alter the frequency of recurrence. However, aggressive cisplatin-ifosfamide-based combination chemotherapy produced a dramatic response in the metastatic tumor in the liver. Cisplatinum, doxorubicin, and ifosfamide may thus be active against this tumor. Regional arterial infusion, when feasible, may enhance response.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1993

Prognostic factors for patients undergoing simple hysterectomy in the presence of invasive cancer of the cervix.

To identify significant prognostic factors and sites of treatment failure in patients undergoing simple hysterectomy in the presence of invasive cervical cancer, the records of 122 women referred following such a procedure were reviewed retrospectively. All but 2 patients received postoperative megavoltage irradiation. Patients with and without gross disease at the start of posthysterectomy treatment had 5-year survival rates of 39 and 75%, respectively. Factors found to be significantly related to survival were the presence of gross disease (P = 0.0001), retrospectively determined tumor stage (P = 0.0001), and lymphangiogram status (P = 0.007). Patients with adenocarcinoma did not fare worse than those with squamous carcinoma (P = 0.6). By multivariate analysis, factors emerging as significantly detrimental to survival were the presence of gross disease (P = 0.0001) and aortic adenopathy on lymphangiogram (P = 0.004). The most common site of treatment failure was the pelvis. The radiotherapy complication rate was 18%; 7% of patients experienced major morbidity. While survival for patients with no residual cancer after simple hysterectomy is favorable, the treatment complication rate may be higher than that reported for patients undergoing primary irradiation. Survival for patients with gross disease at the start of posthysterectomy treatment is poor.

Adenocarcinoma↗

PubMed1993

Cervical cancer in pregnancy: reporting on planned delay in therapy.

OBJECTIVE: To report our experience with invasive carcinoma of the cervix during pregnancy, assessing maternal morbidity due to treatment delay and reporting maternal and fetal outcome. METHODS: Twenty-seven patients with invasive cervical cancer, who were pregnant at the time of diagnosis or treatment, were identified from review of morbidity and mortality statistics between January 1, 1980 and December 31, 1991. All medical records were examined retrospectively. RESULTS: The incidence of cervical carcinoma in our population was 1.2 cases per 10,000 pregnancies. Most patients had stage I lesions. The predominant histologic cell type was squamous cell carcinoma, followed by adenosquamous carcinoma and adenocarcinoma. Eight patients with stage Ia or Ib cervical cancer postponed therapy to optimize fetal outcome, with a mean diagnosis-to-treatment interval of 144 days (range 53-212). Nineteen patients elected immediate treatment, with a mean diagnosis-to-treatment interval of 17 days (range 2-42). Fetal outcome was uniformly good for the delayed-treatment group. Nine fetal deaths and two neonatal deaths occurred in the immediate-treatment group. All patients who delayed therapy are free of disease after a median follow-up of 23 months. CONCLUSION: Deliberate delay of therapy to achieve fetal maturity appears to be a reasonable option for patients with stage I cervical cancer complicating pregnancy.

Adenocarcinoma↗

PubMed1992

Reasons for inappropriate simple hysterectomy in the presence of invasive cancer of the cervix.

We evaluated 148 women who had had simple hysterectomy in the presence of invasive cervical cancer between the years 1973-1987. Two had microinvasive squamous carcinoma for which hysterectomy was not a planned procedure. The remaining 146 women all had either adenocarcinoma or squamous carcinoma exhibiting greater than 3 mm of stromal invasion of lymph-vascular space involvement. Medical records were reviewed retrospectively to determine the reasons for hysterectomy. Causes of inappropriate hysterectomy were as follows: inadequate evaluation of an abnormal Papanicolaou smear or cervical biopsy (21%), failure to perform an indicated conization (12%), deliberate hysterectomy for grossly invasive cancer of the cervix (11%), lack of preoperative Papanicolaou smear (7%), conization margins positive or not evaluated (7%), misreading of pathology results (5%), emergent operation because of bleeding (3%), failure to check cytology preoperatively (1.5%), and failure to biopsy a gross cervical lesion (1.5%). The remaining 31% of cases had normal or inflammatory Papanicolaou smears and negative cervical examinations. Although 93% of this latter group complained of abnormal bleeding, 78% did not have endocervical or endometrial sampling preoperatively. Despite the increasing emphasis on cervical cancer screening, the number of referrals following hysterectomy performed in the presence of cervical carcinoma is not decreasing. Most cases could be avoided by careful adherence to well-established guidelines for cervical cancer detection.

Adenocarcinoma↗

PubMed1991

High-dose, short-duration cisplatin/doxorubicin combination chemotherapy for advanced ovarian epithelial cancer.

Sixty-one patients with epithelial ovarian cancer were treated with intensive high-dose, short-course chemotherapy that consisted of cisplatin (120 mg/m2) and doxorubicin (70 mg/m2) every 3 weeks for four cycles. Patients in complete clinical remission were offered second-look laparotomy (SLL). Patients with minimal or no residual disease at SLL were randomized to either cyclophosphamide (1000 mg/m2 every 21 days for six cycles) or whole-abdominal radiation therapy. All patients completed therapy with a median leukocyte nadir 1.3/microliter and platelet nadir of 90/microliters. Forty-five patients (74%) had a complete clinical response. Results of twenty-two of 36 second-look procedures (64%) showed no evidence of disease (NED). After SLL, 19 patients received six courses of cyclophosphamide and 16 patients received whole-abdominal radiation. Nine patient who refused SLL and one patient with negative SLL findings refused additional treatment. The median survival time for all patients was 51.3 months. High-dose intensive chemotherapy regimens have high response rates, but survival needs to be compared with traditional low-dose regimens. Although high-dose cisplatin and doxorubicin were myelosuppressive, the resulting complications were manageable. There was no significant difference between the mean survival times of patients receiving Cytoxan, abdominal radiation, or no treatment as second-line therapy.

Adult↗

PubMed1991

Unsuspected invasive squamous cell carcinoma of the vulva in young women.

Although the incidence of preinvasive vulvar lesions seems to be rising in the younger population, invasive squamous cell carcinoma remains exceedingly rare. As a result, diagnostic biopsy is often delayed and ablative therapy frequently instituted without an adequate histologic diagnosis. We recently treated three women aged 25 or less who had invasive squamous cell carcinoma of the vulva. In no case was the correct diagnosis initially suspected. All three patients had T2 lesions at the time of diagnosis and were treated by radical wide excision. One patient developed a second ipsilateral vulvar cancer which has recurred in the contralateral groin; the other two patients are free of disease 8 months and 4 years after resection. An awareness of the possibility of invasive vulvar carcinoma, even in the relatively young patient, should lead to prompt and thorough histologic evaluation of any vulvar lesion. Pretreatment evaluation is particularly important when ablation of extensive lesions is planned.

Adolescent↗

PubMed1990

Primary adenocarcinoma of the breast arising in the vulva.

Primary adenocarcinoma of ectopic breast tissue in the vulva has been reported in only four instances. A fifth case, in which estrogen and progesterone receptors were present, is described. Estrogen and progesterone receptor studies may be helpful in identifying adenocarcinoma of uncertain origin.

Adenocarcinoma↗

PubMedDate not supplied

Endometrial cancer patients have a significant risk of harboring isolated tumor cells in histologically negative lymph nodes.

In this study, we examine the prevalence of finding isolated tumor cells (ITCs) in negative lymph nodes of endometrial cancer patients using immunohistochemistry. Seventy-six endometrial cancer patients with lymph nodes histologically negative for metastatic disease were examined. Nodal tissue sections were stained with anticytokeratin antibodies AE-1 and CAM 5.2. Nodes with single or groups of cells (two to four cells) < or =0.2 mm and showing cytokeratin reactivity were positive for ITCs. Findings were compared to features of the primary tumor and patient outcome. ITCs were present in 31 of 1712 lymph nodes. Fifteen (19.7%) patients had ITC-positive nodes. ITCs involved only pelvic nodes in nine cases, only para-aortic nodes in five cases, and pelvic and para-aortic in one case. Tumor in adnexa was the only pathologic feature associated with nodal ITCs (P= 0.0485). All 15 patients with nodal ITCs were alive at follow-up. One (6.7%) patient suffered recurrent disease but was alive at last encounter. Disease recurred in 5 (8.8%) of 57 patients without nodal ITCs. Two are alive without disease, two alive with disease, and one died from her cancer. In summary, a significant proportion of endometrial cancer patients have ITCs detected by immunohistochemistry in histologically negative regional lymph nodes.

Adult↗