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L S Massad

Publications and source records attributed to L S Massad.

At least 37 records · Page 2Linked to original sources
PubMed1999

Predicting compliance with follow-up recommendations after colposcopy among indigent urban women.

OBJECTIVE: To determine correlates of compliance with follow-up recommendations after colposcopy. METHODS: Between October 1, 1992, and June 30, 1997, management recommendations were made to 451 consecutive women who attended a resident colposcopy clinic. Compliance was determined after 8-12 months. Correlates of compliance were assessed by univariate and multivariate analyses. RESULTS: Recommendations included repeat cytology in 6 months for 252 women, loop excision for 114, conization for 27, repeat colposcopy for 51, other for three, and not recorded for four. Rates of ever complying were 81% for loop excision, 85% for conization, 62% for repeat colposcopy, and 36% for repeat cytology. In multivariate analysis, the only significant predictors of compliance were history of genital herpes simplex infection (odds ratio [OR] 0.20; 95% confidence interval [CI] 0.05, 0.86, P = .03) and the nature of the recommendation (OR 4.73; CI 2.51, 8.92 for loop excision; OR 8.72; CI 2.57, 29.6 for conization; and OR 2.53; CI 1.30, 4.93 for repeat colposcopy, all against observation, P<.001). CONCLUSION: After colposcopy, women were more likely to comply with earlier, more intensive interventions, although the relative effect of follow-up interval and intervention could not be distinguished.

Adolescent↗
PubMed1998

Chemokines are present in the genital tract of HIV-seropositive and HIV-seronegative women: correlation with other immune mediators.

In this cross-sectional study, 53 cervicovaginal lavage samples (CVL) from 41 women were analyzed for the chemokines interleukin-8 (IL-8), regulated-on-activation normal T-expressed and secreted (RANTES) factor, and macrophage inflammatory protein-1alpha (MIP-1alpha) by enzyme-linked immunosorbent assay (ELISA). IL-8 was detected in 81% of CVL, whereas RANTES was detected in 32%, and MIP-1alpha in 15% of the CVL. The mean levels of IL-8, RANTES, and MIP-1alpha in positive samples were 396 pg/ml, 102 pg/ml, and 34 pg/ml, respectively. IL-8 levels correlated positively with IL-1beta and IgG in a subset of CVL samples. RANTES levels correlated positively with complement protein levels. Additionally, the levels of RANTES, but not MIP-1alpha, reached levels reported in previous studies of the effects of beta chemokines to inhibit HIV replication. These results suggest that measuring chemokines in CVL specimens can provide important information regarding immune responses in the genital tract.

Cervix Uteri↗
PubMed1997

Evaluation of immunologic markers in cervicovaginal fluid of HIV-infected and uninfected women: implications for the immunologic response to HIV in the female genital tract.

We analyzed 21 cervicovaginal lavage (CVL) specimens from 19 women participating in the Women's Interagency HIV Study to characterize levels of antibody, cytokine, and complement and to determine associations between these levels and stage of the menstrual cycle, HIV status, and the presence of concurrent genital infection and genital dysplasia. Sixteen samples were collected from HIV-infected women and five from high-risk HIV-seronegative women. CVL fluid was assayed for levels of IgG, secretory IgA (s-IgA), interleukin 2 (IL-2), IL-10, IL-6, tumor necrosis factor alpha (TNF-alpha), IL-1beta, interferon gamma (IFN-gamma), C3, C1q, and C4. Women with HIV were more likely to have cervicovaginal dysplasia (9/16 vs. 0/5; p = 0.027) but were not more likely to have concurrent vaginal infection (10/16 vs. 2/5; p = 0.38). Antibody, cytokine, and complement were detectable in all samples, although not all samples had measurable IL-10, C3, or C4. HIV-infected women demonstrated a trend toward higher levels of IFN-gamma than did uninfected women (p = 0.098); no differences were noted in other parameters. HIV-infected women with vaginal infections had significantly higher CVL levels of IgG (p = 0.023) and IFN-gamma (p = 0.02) than did HIV-infected women without genital infections. HIV-infected women with cervicovaginal dysplasia were found to have higher levels of IL-1beta (p = 0.045) and IFN-gamma (p = 0.039) than those without. Analysis of the HIV-infected cohort by CD4 cell count revealed higher levels of IgG and IFN-gamma in CVL from women with lower CD4 cell counts, although these differences were not statistically significant. Higher levels of proinflammatory cytokines in CVL fluid of women with genital infection or cervicovaginal dysplasia may affect local HIV replication and may influence the risk of acquisition or transmission of HIV for women with these underlying conditions.

Adult↗
PubMed1997

Correlating cone biopsy histology with operative indications.

OBJECTIVE: To correlate operative indications for and histologic findings of cold knife cone biopsy since introduction of the Bethesda system for classification of cervical cytology. METHODS: Patients undergoing cold knife conization of the cervix at adjacent urban medical centers were identified from operating logs. Data on indication and outcome were tabulated retrospectively for 294 women. RESULTS: Cone biopsy indications were sometimes multiple and included dysplastic or malignant endocervical curettage (ECC) in 66%, inadequate colposcopy in 48%, cytologic:histologic discrepancy in 16%, and suspicion of invasive cancer on biopsy in 1% of cone biopsies. For 8% of patients, none of these indications were found. The respective proportions of women with benign findings or atypical, low-grade dysplasia, high-grade dysplasia, or cancer was 16, 15, 65, and 3% for positive ECC, 26, 16, 54, and 4% for inadequate colposcopy, 22, 17, 59, and 0% for discrepancy, and 0, 0, 100, and 0% for suspicion of cancer on cytology. Outcomes were significantly worse among women with positive ECC (OR = 2.1, P = 0.006). CONCLUSIONS: The likelihood of identifying high-grade lesions in cone biopsy specimens is high, especially among women with a positive ECC, but the risk of cancer is low.

Adolescent↗
PubMed1997

A potent activator of HIV-1 replication is present in the genital tract of a subset of HIV-1-infected and uninfected women.

OBJECTIVE AND DESIGN: To determine whether the female genital tract contains factors that affect HIV-1 replication. Cervicovaginal lavage (CVL) samples were collected from HIV-1-seropositive and seronegative women and added to cell cultures. METHODS: HIV p24 production was used to measure the effects of CVL on replication of HIVMN in a T-cell line, of a primary isolate in peripheral blood mononuclear cells, or on HIV expression by the latently-infected monocytic U1 cell line. The effects of CVL on the HIV long terminal repeat (LTR) were determined in 1G5 T cells by measuring luciferase activity. RESULTS: Increased replication of HIVMN and a primary isolate were observed in T cells cultured with CVL samples from three out of 38 HIV-infected women, one out of four uninfected high-risk women, and none of 12 low-risk women. The CVL factor increased replication by enhancing virus expression via activation of the HIV LTR. The HIV-inducing activity was highly stable to heat but was sensitive to proteases, indicating that the activity was distinct from heat-labile cytokines including tumour necrosis factor-alpha. CONCLUSIONS: This is the first study to show that a factor which can stimulate HIV-1 replication is present at biologically active levels in the reproductive tract of women. This factor could potentially affect sexual or vertical transmission of HIV-1 by altering genital tract virus load or virus expression.

Cells, Cultured↗
PubMed1997

Knowledge of cervical cancer screening among women attending urban colposcopy clinics.

To determine knowledge about cervical cancer screening among women referred to urban colposcopy clinics and to assess effects of colposcopy and directed teaching on knowledge deficits, a closed-ended questionnaire was distributed to 144 women at a university resident clinic before and after initial colposcopy. Results were compared with those of 42 patients attending a health maintenance organization (HMO) for the same procedure. Fewer than half of clinic patients correctly identified the nature of a Pap smear or the reason for their referral, but 84% knew that Pap smears were indicated annually. Fewer than 60% knew the nature of colposcopy or the organ that it evaluated, but 74% could identify its indication. Clinic patients' knowledge of colposcopy but not of Pap smears improved after colposcopy and teaching. While HMO patients had better overall understanding of Pap smears and colposcopy, a multivariate analysis found educational level to be the only significant predictor of this knowledge. Efforts to boost cervical cancer screening through improved understanding should be directed toward women with the least schooling without regard to other demographic factors.

Adolescent↗
PubMed1996

Correlation between colposcopically directed biopsy and cervical loop excision.

Colposcopy is standard for diagnosis of cervical cancer precursors, but the development of diathermy loop electrodes for excision of the cervical transformation zone offers a technique for validation. Loop excision of the transformation zone was performed for 47 consecutive women with dysplasia in colposcopically directed biopsies using 20 x 8-mm electrodes. Specimens were marked for orientation and serially sectioned. All pathology material was reviewed. Although 28% of women had disappearance of dysplasia at the biopsy site, only 9% had no dysplasia in the transformation zone. Half of the women with CIN 1 on directed biopsy had high-grade lesions found in loop excision specimens. Significant discrepancies may be found between the results of colposcopically directed biopsy and loop excision.

Adult↗
PubMed1996

Interferon-alpha and all-trans-retinoic acid reversibly inhibit the in vitro proliferation of cell lines derived from cervical cancers.

Interferon and retinoic acid are active agents for the treatment of cervical cancer, but their mechanisms of action are unclear. Results of [3H]thymidine uptake assays showed that exposure to pharmacologic concentrations of interferon-alpha (IFN-alpha) and all-trans-retinoic acid (RA) for 72 hr inhibited growth of the cervical cancer cell lines ME-180, 283, SiHa, C33-A, 621, CaSki, HeLa, and B132, CaSki and SiHa cells continuously exposed to IFN-alpha or RA or both for 9 days developed resistance to growth inhibition, and growth resumed at a rate comparable to control after removal of agents. Similar assays showed no significant difference in effects of RA and its cis isomer. Assays for lactate dehydrogenase release revealed no significant lysis of any cell line following exposure to IFN-alpha, RA, or their combination. In organotypic culture, cells grew in a pattern histologically similar to carcinoma in situ, and exposure to IFN-alpha and RA for 14 days yielded no change in this pattern. Immunohistochemical analysis showed no change in cytokeratin expression by cells in organotypic or monolayer culture. The major in vitro effect of IFN-alpha and RA on cervical cancer cell lines appears to be reversible inhibition of proliferation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Colposcopic and cytologic findings among adolescents referred to two urban teaching hospitals.

STUDY OBJECTIVE: To determine colposcopic findings among adolescents and to determine compliance with management recommendations. DESIGN: Retrospective review of colposcopy logs and patient charts. SETTING: Two urban resident colposcopy clinics. PARTICIPANTS: Low-income, predominantly minority girls 16 years of age or younger referred for evaluation of abnormal cervical cytology. INTERVENTION: Colposcopy with directed biopsy. MAIN OUTCOME MEASURES: Histologic findings in colposcopic biopsies and compliance with management recommendations. RESULTS: Of 62 adolescents evaluated, 17 (27%) had biopsies showing atypia or koilocytosis and 13 (21%) had dysplasia, with grade 2 cervical intraepithelial neoplasia (CIN 2) in 5 (8%). No biopsy showed CIN 3 or invasive cancer. None of 31 endocervical curettings contained dysplasia. Forty-one adolescents (66%) failed to comply with recommendations for surveillance or treatment. CONCLUSIONS: The prevalence of dysplasia among adolescents referred for colposcopy is substantial, and better strategies are needed to ensure proper follow-up.

Adolescent↗
PubMed1996

Pelvic inflammatory disease. Correlation of severity with CA-125 levels.

OBJECTIVE: To determine whether elevated levels of cancer antigen 125 (CA-125) correlate with the severity and clinical outcome of pelvic inflammatory disease. STUDY DESIGN: CA-125 levels were measured prospectively in 36 women with pelvic inflammatory disease using a commercial immunoassay. Initial inclusion criteria were abdominal tenderness, cervical motion tenderness and adnexal tenderness. Patients then were categorized into three groups based on the severity of the illness. Group 1 included patients with (1) temperature > or = 38.0 but < 38.5 degrees C or (2) WBC count > or = 10 but < 15 x 10(3) cells/microL. Group 2 included patients with (1) temperature > or = 38.5 degrees C or (2) WBC count > or = 15 x 10(3) cells/microL. Group 3 included patients who fulfilled the same criteria as group 2 but who also had an adnexal mass. Differences in CA-125 levels were compared statistically using the unpaired Student t test. RESULTS: All patients with the diagnosis of pelvic inflammatory disease had CA-125 levels > 30 U/mL, with a range of 48-656. Moreover, the levels were significantly different among the three groups (group 1 vs. 2, P = .002; 1 vs. 3, P = .001; 2 vs. 3, P = .001), and a correlation between severity of disease and CA-125 levels was found. All patients with a presumed pelvic abscess had CA-125 levels in the range for neoplastic processes. CONCLUSION: Elevated CA-125 levels correlate with the severity of pelvic inflammatory disease and outcome. Pelvic inflammatory disease must be considered in the differential diagnosis of elevated CA-125 levels and pelvic masses.

Adolescent↗
PubMed1996

A bleomycin/ifosfamide/cisplatin regimen exhibits poor activity against persistent or recurrent squamous gynecologic cancers.

Persistent or recurrent squamous malignancies of the female genital tract are usually incurable by conventional therapy, and results of single agent chemotherapy have been disappointing. We undertook this study to confirm a previously reported response rate of 69%, using a regimen of bleomycin 30U, ifosfamide 5g/m2 with mesna 6g/m2, and cisplatin 50 mg/m2 (BIP) for recurrent cervical cancer. This regimen was used to treat persistent or recurrent squamous cancers in women with cervical cancer (n = 11), vaginal cancer (n = 1) and vulvar cancer (n = 1). Results were reviewed retrospectively and toxicities graded according to the criteria of the Gynecologic Oncology Group. No complete responses were seen. One patient had a partial response (10%, 95% confidence interval 0-28%). Five patients (50%), exhibiting stable disease during therapy with BIP, progressed after cessation of therapy. Of 9 women with symptoms after one cycle. Significant toxicities included neutropenic fever (3 grade 3, 3 grade 4), emesis (1 grade 3), confusion (2 grade 4), vaginal bleeding (2 grade 3), and renal failure (1 grade 3). Eight patients were transfused with a total of 28 units of red cells. After 23 months of follow-up, all patients were dead of disease. Mean survival was 10 months. Toxicity associated with this regimen can be significant, and results appear no better than those reported with single agent therapy.

Adult↗
PubMed1995

Ability of visual tests to predict underlying cervical neoplasia. Colposcopy and speculoscopy.

OBJECTIVE: To describe the attributes of colposcopy and a low-power, magnified examination that utilizes chemiluminescent illumination (speculoscopy) in the visualization of cervical epithelium in a predefined, high-risk population and to compare how the two tests predict cervical histology. STUDY DESIGN: During this multicenter, prospective study, 395 women who were referred to our colposcopy clinic underwent a repeat cervical smear and speculoscopy followed immediately by colposcopy. Abnormal colposcopic lesions were biopsied and endocervical curettage performed when indicated. Histologic diagnoses were compared with cytology, speculoscopy and colposcopy results. RESULTS: Colposcopy was more sensitive than speculoscopy in the detection of cervical neoplasia (97% vs. 82%) (P < .001) and was superior in visualizing focal lesions and vascular patterns. An antecedent acetowhite abnormality detected during speculoscopy was highly predictive of subsequent abnormal colposcopy (97% positive predictive value). The "overall" rate of acetowhite lesions during speculoscopy was nearly half the rate during colposcopy (P < .001). CONCLUSION: Colposcopy is better suited than speculoscopy to the follow-up of patients with abnormal cervical cytology because it facilitates lesion grading and assists in directing biopsies. Speculoscopy is best utilized as a dichotomous screening test based on the presence or absence of at least one well-demarcated acetowhite lesion and may be more suitable than colposcopy as an adjunct to cervical cancer screening due to its lower overcall rate. The biophysical properties of blue-white chemiluminescent light as it relates to the diagnosis of cervical neoplasia are discussed.

Adult↗
PubMed1994

Prognostic indicators of survival in advanced endometrial cancer.

Advanced endometrial cancer represents 14% of all stages but 54% of all deaths attributed to endometrial cancer. From 1973 to 1990, the charts of 137 patients with endometrial cancer (Stage III and IV) treated by the section of Gynecologic Oncology at Rush Medical College were retrospectively reviewed. The log rank method was used for univariate analysis and Cox proportional hazards regression was used for multivariate analysis. The patients were stratified as follows: Stage III, 92 (67.2%), Stage IV, 45 (32.8%); Grade 1, 15 (10.9%), Grade 2, 47 (34.3%), Grade 3, 67 (48.9%); adenocarcinoma, 93 (67.9%), adenosquamous, 18 (13.1%), adenoacanthoma, 2 (1.5%), clear cell, 1 (0.7%), papillary serous, 23 (16.8%). Using univariate analysis, median survival was 1.71 years for Stage III versus 0.68 years for Stage IV. Median survival based on treatment was as follows: radiotherapy (RT) only (n = 16), 0.89 years, surgery only (n = 36), 0.75 years, preoperative RT+surgery (n = 7), 2.5 years, surgery+postoperative RT (n = 56), 2.63 years, and other treatments (hormonal only n = 12, chemotherapy only n = 1, and no treatment n = 9), 0.6 years. Patients with vaginal extension survived a median of 0.82 years, versus 2.49 years without this factor (P = 0.002). Patients with clinically apparent parametrial involvement survived a median of 0.70 years versus 2.65 years without this factor (P = 0.0003). Multivariate analysis was possible via a surgical database (n = 99). Age > 60 (P = 0.01), parametrial involvement (P = 0.04), and abdominal metastases (P = 0.003) were significant prognostic indicators. Papillary or clear cell histology, advanced grade, and mode of treatment were not significant. Patients with abdominal metastases or parametrial extension of tumor have a significant decrease in mean survival.

Age Factors↗
PubMed1994

Salvage mitomycin/5-fluorouracil after platinum-based therapy for women with advanced ovarian cancer and related gynecologic malignancies.

PURPOSE: to determine response rates, survival, and toxicity of a regimen of mitomycin-C and 5-fluorouracil in patients previously treated with platinum-based combinations for ovarian cancer and related gynecologic malignancies. PATIENTS AND METHODS: retrospective chart review of all cases of persistent or recurrent ovarian, fallopian tube, and peritoneal carcinoma treated with mitomycin-C 7 mg/m2 followed by continuous infusion of 5-fluorouracil 600 mg/m2/day over 4 days. RESULTS: 26 patients were treated after a median of 2 prior platinum-based regimens, 22 with ovarian cancer, 3 with peritoneal cancer, and one with fallopian tube cancer. Only 2 patients completed 6 or more cycles. 2 patients had partial responses (8%); no complete responses were seen. 24 patients died a median of 3 months after the initiation of therapy, while 2 patients were alive 4 and 8 months after beginning therapy. All deaths were attributable to disease, not complications of treatment. 8 patients required dose modification or treatment delay for toxicity. Nine patients required a total of 11 unscheduled admissions. CONCLUSIONS: toxicity attributable to mitomycin-C/5-fluorouracil therapy of ovarian cancer is acceptable, but responses are few. More effective alternative should be sought.

Adult↗
PubMed1993

Correlates of length of stay in gynecologic oncology patients undergoing inpatient surgery.

Escalating economic constraints require identification of the determinants of length of stay (LOS), since optimizing these may facilitate cost-effective care. However, risk factors for increased LOS are poorly understood. In order to identify correlates of long LOS, we retrospectively reviewed the charts of 252 consecutive patients who underwent major inpatient surgery on the gynecologic oncology service at Barnes Hospital during 1990. Of these, 86 had benign disease and 38 were excluded for other reasons, leaving 128 for analysis. The recorded variables of age, race, medical history, measures of nutritional state, primary cancer, prior therapy, blood loss, operating time, and attending surgeon were subjected to regression analysis. In order to avoid reducing cell numbers to insignificant sizes, the linked factors of type of surgery and primary site were not analyzed simultaneously. A separate analysis was performed substituting type of procedure for primary site. The mean LOS was 12 days (range, 4-30). Five factors emerged as significant correlates of longer LOS: decreasing preoperative albumin level (P < 0.001) and hemoglobin level (0.029), increasing age (0.017), operative blood loss (0.039), and prior platinum-based chemotherapy (0.043). Presence of vulvar and fallopian tube primaries was associated with significantly shorter LOS (0.023 and 0.037). Together these factors accounted for 36% of total variance in LOS. Substituting procedure type for primary site accounted for 37% of total variance in LOS and showed that only bowel surgery (0.001) and preoperative intracavitary implant were significantly correlated with longer LOS. Factors not associated with LOS (P > 0.05) were race, attending physician, number of preoperative medications or medical conditions, body mass index, other radiotherapy, and other primary sites and procedures. Future studies should attempt to determine why elderly, nutritionally depleted women undergoing long or complicated procedures are at high risk for long LOS and should assess interventions designed to minimize LOS for this high-risk group.

Adolescent↗
PubMed1993

Use of speculoscopy in the evaluation of women with atypical Papanicolaou smears. Improved cost effectiveness by selective colposcopy.

Since up to 45% of patients with atypical Papanicolaou smears have been shown to have significant pathology, women with persistent atypia are usually referred for colposcopy. This study evaluated the use of a new adjunctive screening test, speculoscopy, in selecting women with atypical Papanicolaou smears who would most benefit from referral for colposcopy. Both screening and referral patients were evaluated with the Papanicolaou smear, speculoscopy and colposcopy at 10 study centers. Biopsies were obtained from most women with positive colposcopy. The results in patients with atypical smears were used to perform a cost-benefit analysis of each of three management protocols. Using the results of speculoscopy to select women with atypical Papanicolaou smears for colposcopy provided a cost-effective alternative to performing colposcopy either on all women or on those with persistent atypia following treatment. Even when all women undergo speculoscopy at the time of screening, this protocol provides a cost savings of up to 24% and no significant loss of diagnostic accuracy. These data suggest that speculoscopy performed at the time of initial screening can accurately select women with atypical Papanicolaou smears who require colposcopy for diagnostic biopsy in a cost-effective manner.

Biopsy↗