Biomedical subjects
Publications and source records attributed to M Spitzer.
Human papillomavirus (HPV) has been strongly associated with malignancy in the female lower genital tract. Because squamous-cell carcinoma of the cervix is preceded by a spectrum of easily detectable and treatable premalignant changes, it is very preventable. The management of the patient with an abnormal Papanicolaou smear and the treatment of cervical, vaginal, and vulvar disease are outlined.
In a retrospective study, data from 99 male and female inpatients with alcohol withdrawal syndrome or alcohol withdrawal delirium, treated between 1977 and 1987, were analyzed. DSM-III criteria were used to assign the diagnosis of either withdrawal delirium (with obligatory clouding of consciousness) or alcohol withdrawal syndrome (without disturbances of consciousness and/or perception). No statistically significant differences between the two groups were found with respect to the red and white blood count, liver enzymes, and electrolytes. Significant differences were found in calcium levels, lymphocyte counts, and in electrophoresis. However, these differences are of no use for diagnostic purpose. Moreover, they are unspecific with respect to etiology. Hence, the distinction between alcohol withdrawal syndrome and alcohol withdrawal delirium can only be made clinically, i.e., it is dependent on the presence or absence of a clouded consciousness. This is in line with the findings published by other investigators. In the light of our metabolic findings, alcohol withdrawal syndrome and alcohol withdrawal delirium represent the two extremes of a continuum rather than two separate nosological entities.
A rare case of non-Hodgkin's lymphoma stage IE complicating pregnancy is presented. The diagnosis was made by biopsy at 28 weeks gestation and treated with 2635 rad of external radiotherapy with abdominal and pelvic shielding beginning at 30 weeks gestation. Following delivery, the patient received combination chemotherapy and is disease-free 6 years later. The baby, weighing 2015 g, was delivered by cesarean section at term. The effects of radiotherapy on a fetus are reviewed and the factors that were considered in the treatment of this patient are discussed. Radiotherapy with protective shielding can be an effective initial modality of treatment in this setting.
PDT is a technique in which visible light is used in combination with photosensitizing agents to achieve a tumoricidal effect. Hematoporphyrins are the most commonly used photosensitizers in clinical practice. DHE is the active fraction of hematoporphyrin. Intravenously injected DHE is found in highest concentration in the liver followed by the spleen, kidney, tumor, skin, muscle, brain, and lungs. The strongest absorption bands for DHE are in the blue region of the spectrum, and this helps to account for the skin toxicity associated with PDT. Red light, at the wavelength of 630 nm, is usually used clinically because of its greater tissue penetration. Techniques such as photobleaching and use of photosensitizers that have weak absorption bands at the lower wavelengths may reduce cutaneous toxicity in the future. Other approaches, such as the use of monoclonal antibody-linked photosensitizers or cationic photosensitizers that are specifically localized in tumor cells, may also increase the effectiveness of PDT while decreasing toxicity. Light for PDT is usually provided by argon-pumped dye lasers or metal vapor lasers. Diode lasers will be used in the future. The use of fiber-optics and diffusing lenses allows the endoscopic and interstitial use of PDT. The mechanism of action of PDT involves the formation of singlet oxygen, which oxidizes biologic molecules and causes irreversible subcellular damage. The major in vivo effect of PDT is caused by its destruction of tumor vasculature, causing anoxia and necrosis. The use of PDT in gynecology has been limited. Several investigators have reported mixed results in treating lower genital tract intraepithelial and recurrent malignant tumors using a variety of approaches involving PDT. The use of PDT in other similar, though nongynecologic, tumors offers a direction for future research.
The goal of this study was to evaluate the histologic criteria used to establish the diagnosis of human papillomavirus (HPV)-associated disease, especially in borderline lesions. In a completely blinded study, 21 patients had one biopsy each of the cervix and vulva. Each specimen was evaluated by RNA and DNA in situ hybridization, a histologic diagnosis was rendered, and then each was evaluated for 12 histologic criteria commonly associated with HPV. On the cervix only binucleation and dysplasia correlated well with in situ hybridization. Koilocytosis correlated very strongly with the histologic diagnosis. On the vulva, koilocytosis, papillomatosis, elongated rete pegs, binucleation, and hypergranulosis correlated well with in situ hybridization. When four other pathologists reviewed the slides, they agreed on the histologic diagnosis and the presence of koilocytosis, binucleation, and dysplasia on the cervix but on none of the other criteria. On the vulva the pathologists disagreed on the overall diagnosis and the presence of any of the criteria with the exception of papillomatosis. Nonclassic histologic criteria should not, by themselves, be used to make the diagnosis of condyloma. The use of such terminology as "suggestive of condyloma" in histologic diagnoses should be avoided in favor of more descriptive terminology to avoid possibly unnecessary treatment for lesions of questionable significance.
The diagnosis of lesions associated with human papillomavirus infection can be difficult because the results of the tests used can be contradictory. Our goal was to compare some of these tests and to evaluate their comparative strengths and weaknesses as clinically useful tools in confirming the diagnosis, especially in borderline cases. Twenty-one consecutive patients from our colposcopy clinic were screened with cytology and colposcopy. Biopsies were taken from representative areas on the cervix and vulva and divided. One-half was evaluated with Southern blot hybridization and the other half with histology and with RNA and DNA in situ hybridization. Cytology and histology were interpreted as either "positive" (showing definite evidence of human papillomavirus infection or cervical intraepithelial neoplasia [CIN]), "negative" (showing no evidence of human papillomavirus infection or CIN) or "equivocal" (atypical [class II] Papanicolaou smears or histology suggestive but not diagnostic of condyloma). In order to determine the clinical significance of equivocal results the sensitivity and specificity of these tests were calculated, with the equivocal results reclassified as either positive or negative. Colposcopy was the most sensitive technique but was not very specific. Cytology was a very sensitive screening tool when the atypical (class II) smears were considered positive but not when they were considered negative. The specificity of the histologic diagnosis was doubled with the equivocal results considered negative when compared to the specificity of the histologic diagnosis with the equivocal results considered positive, with no loss of sensitivity. Each technique has drawbacks, and therefore no one should be used to diagnose and treat these lesions to the exclusion of all others.
Thirty-eight postmenopausal women and one with pituitary amenorrhea underwent cervical laser surgery. The cervical canal of each patient was patent 2 weeks later. Eighteen of the 30 women reevaluated 4-48 months later had total obliteration of the cervical canal. In some patients, the cervix was obliterated and flush with the vaginal vault so that it could not be identified. Five other patients had severe cervical stenosis. Factors contributing to cervical os obliteration appeared to be the depth of the cervical defect, the lack of the physical action of blood passing through the cervical canal, and the hypoestrogenic state. This outcome makes continued adequate cytologic and colposcopic surveillance of these patients impossible and leaves them at risk for developing unrecognized cervical and endometrial disease.
A total of 269 human pronuclear embryos and 84 oocytes were subjected to four different protocols of cryoprotectant equilibration, washing out and freeze-thawing. The morphological survival, rate of development, fertilization in vitro and overall survival rate were estimated in the groups of fresh, aged oocytes, diploid and multipronuclear embryos used. With some restrictions, the conclusion can be drawn that slow, low intermediary temperature 1,2-propanediol (1,2-PROH) and 1,2-PROH/dimethyl sulphoxide (DMSO) systems are superior to the rapid, high intermediary temperature 1,2-PROH and the traditionally used DMSO systems. The best success rates were reached with the combination of cryoprotectants in the low intermediary temperature group. Thirty-three patients had 37 transfers of cryopreserved pronuclear embryos (n = 103), resulting in eight pregnancies (24.2% per transfer) thus doubling the pregnancy rate in the stimulation cycles for the same period (21% per transfer). Thawing at a rate of 50 degrees C/min is not incompatible with the survival of slowly frozen human oocytes and pronuclear embryos cooled to an intermediary temperature of -70 degrees C using the DMSO system.
Topical benzocaine 20% gel was evaluated for its ability to reduce pain associated with several common gynecologic procedures. In the first phase of the investigation, designed to determine the efficacy of the gel, 40 women received it before one or more of five procedures (cervical biopsy, intrauterine device insertion, endocervical curettage, paracervical block, and tenaculum placement). These women reported significantly less pain than 42 control subjects (P less than .05 to P less than .0005). In the second phase of the study, a placebo gel was compared in a blind fashion with 20% benzocaine gel in 63 study subjects and 64 control women undergoing procedures similar to those in the first part of the study. The modal pain rating by both physician and patient was "none" in the study group for all procedures except endocervical curettage, for which the rating was "mild"; ratings were "mild" or "moderate" in the control group. Compliance with respect to keeping follow-up visits was significantly greater in the study group. These data indicate that benzocaine 20% significantly reduces the pain experienced by patients after many gynecologic procedures performed vaginally.
Two hundred fifty-one consecutive patients from our colposcopy clinic were evaluated to establish the extent to which human papillomavirus (HPV) infection is a disease of the entire female lower genital tract. Colposcopic examinations and biopsies of the cervix and vulva were performed on all patients. Two hundred two women had cervical disease, of whom 164 (81%) also had vulvar disease. The percentage was the same regardless of the severity of the cervical disease. One hundred ninety-four of the patients had vulvar disease and of these, 164 (85%) also had cervical disease. Twenty-nine of 37 women (78%) with overt vulvar condylomata had cervical disease; 15 of these presented without a Papanicolaou smear, and 13 had cervical disease. We conclude that HPV infection of the female lower genital tract is a multicentric disease. All patients with evidence of HPV infection should undergo colposcopic evaluation of the entire lower genital tract. The significance that this will have on future attempts to cure this infection needs to be studied.
In the world's literature, only 16 patients with parovarian malignancies have been described, five of which have been of low-malignant potential. All but one of these low-malignant potential lesions have been serous tumors. This is the second low-malignant potential parovarian tumor to be described with mucinous and serous components as well as hobnail cells. These tumors occur almost exclusively in young women, yet they are so rare that no treatment plan has been developed. We propose that until more data becomes available, these low-malignant potential lesions be treated as are their ovarian counterparts with staging laparotomy and surgery which conserves reproductive functioning being appropriate for women who meet the rigid clinical and histologic criteria for a very early potentially nonaggressive tumor, and complete extirpative surgery for those who do not.
Empirical findings and arguments in the hitherto controversial field of experimental psychosis are reviewed historically and systematically. Similarities and differences of experimental psychosis and schizophrenia are discussed on the background of disturbances of perception, consciousness and ego experience ("reflektierender Ich-Rest"). Better psychopathological, biochemical and neuropsychological assessment strategies could lead to a revival of experimental psychosis which some brief suggestions are made for.
Explore the source record for details and available documents.
Three patients undergoing laser surgery of the vagina developed high fevers that later regressed, one of them without treatment. The possible causes and implications of these cases are discussed.
To support the discussion of the DSM-III as well as to facilitate its clinical use, its diagnostic categories are contrasted with the diagnostic categories of the ICD-9.
The concept of pseudohallucinations is investigated systematically and historically with regard to its content. Its ambiguity (different authors have different concepts) as well as its vagueness (the explication of its meaning leads to contradictions) are shown. Therefore, we propose to drop the concept of pseudohallucinations for clinical practice. Less ambiguous terms should be used or facts previously termed "pseudohallucinations" should be described without using a superior general term.
In an attempt to establish the significance and management of the atypical Papanicolaou smear, 97 patients with atypical Papanicolaou smears were each evaluated with a repeat Papanicolaou smear, cervicography, and colposcopy. In the detection of significant lesions, cervicography was more sensitive than a repeat smear, but less so than colposcopy. Forty-two percent of the colposcopically detected lesions would have gone undetected by repeat Papanicolaou smears, compared with 11% by cervicography. However, Papanicolaou smears were more specific than cervicography (55 versus 29%). The cost per case detected using cervicography for triage was equal to that using follow-up Papanicolaou smears, but was a third higher than referring all patients directly to colposcopy. Merely using repeat smears in patients with atypical Papanicolaou smears may result in nondetection of many significant lesions, especially in populations where follow-up is poor.