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Biomedical subjects

O Abulafia

Publications and source records attributed to O Abulafia.

At least 37 records · Page 2Linked to original sources
PubMed2000

Angiogenesis in early-invasive and low-malignant-potential epithelial ovarian carcinoma.

OBJECTIVE: To evaluate angiogenesis in ovaries of women with stage I invasive and low-malignant-potential epithelial ovarian carcinoma. METHODS: Ovarian specimens of 49 consecutive women with primary stage I invasive (n = 15) or stage I low-malignant-potential epithelial ovarian carcinoma (n = 34) were stained immunohistochemically for factor VIII-related antigen. Microvessel counts were tested for correlation with patient age, race, parity, previous oral contraceptive use, histologic type, tumor grade, tumor size, ascites, tumor excrescences, and disease-free and overall survival. Statistical analysis included multiple linear regression, Student t tests, factorial analysis of variance, and Cox proportional hazards regression, with P <.05 considered statistically significant. RESULTS: Microvessel counts of ovarian specimens of women with stage I invasive epithelial ovarian carcinoma (median 30, range 17-73) were significantly higher than those of women with stage I low-malignant-potential epithelial ovarian carcinoma (median 10, range 5-23), (P <.001). Among women with low-malignant-potential disease, microvessel counts did not differ significantly between serous and mucinous carcinomas (median 10, range 5-23 versus median 11, range 5-20, respectively, P =.78). There was no correlation between microvessel counts and age, tumor grade, tumor size, ascites, or tumor excrescences. CONCLUSION: Angiogenesis as assessed by microvessel counts is more intense in stage I invasive ovarian epithelial carcinoma compared with stage I low-malignant-potential carcinoma, and might assist in differentiating between these histopathologic entities.

Adolescent↗
PubMed2000

Hyperemesis gravidarum: a current review.

Hyperemesis gravidarum or pernicious vomiting of pregnancy affects between 0.3% and 2% of all pregnant patients. The objective of this paper is to review current literature pertaining to epidemiology, etiology, symptomatology, complications, treatment, and perinatal outcome of patients with hyperemesis gravidarum. We performed a MEDLINE search of the English literature from 1966 through January 2000 utilizing the keywords: hyperemesis gravidarum, nausea and vomiting, and pregnancy. Current data pertaining to epidemiology, etiology, clinical manifestations, differential diagnosis, complications, various treatment modalities, subsequent perinatal outcome and recent developments are presented. Review of the literature supports that hyperemesis gravidarum is a multifactorial disease in which pregnancy-induced hormonal changes associated with concurrent gastrointestinal dysmotility and possible Helicobacter pylori infection function as contributing factors. Therapeutic key elements are mainly supportive in conjunction with antiemetic medication. It appears perinatal outcome is unaffected.

Antiemetics↗
PubMed2000

The role of angiogenesis in the accumulation of peritoneal fluid in benign conditions and the development of malignant ascites in the female.

Our objective was to present current data pertaining to the role of angiogenesis in the accumulation of peritoneal fluid in both benign conditions and in the development of malignant ascites in the female. To this goal, we conducted a computerized search to identify all relevant studies published in the English literature. MEDLINE, Current Contents and Index Medicus were searched utilizing the terms: angiogenesis, peritoneal fluid, ascites, vascular endothelial growth factor (VEGF), therapy and carcinoma through May 2000. Review of the literature supports that angiogenesis promoted by VEGF is associated with fluid accumulation in animal and human tumor effusions. Benign conditions involving accumulation of peritoneal fluid and associated angiogenesis in the female include ovulation, endometriosis and severe ovarian hyperstimulation syndrome. Malignant intra-abdominal conditions associated with increased VEGF activity include primary epithelial ovarian, gastric and colon carcinomas, omental and hepatic metastatic disease. Initial trials with antiangiogenic (angioinhibitor) therapy such as anti-VEGF antibodies, anti-VEGF receptor antibodies, tumor necrosis factor, and metalloproteinase inhibitors have been reported and antitumor activity observed in a limited number of patients with advanced (inoperable or metastatic) disease.

Animals↗
PubMed2000

Estrogen, progesterone and the gastrointestinal tract.

Administration of postmenopausal hormonal replacement therapy (HRT) is increasing. Both estrogen and progesterone have established effects upon the gastrointestinal tract. Our objective was to review the current literature and inform the primary care obstetrician-gynecologist of the physiologic and possible therapeutic effects of estrogen and progesterone upon the gastrointestinal tract. We performed a MEDLINE search of the English-language literature from 1966 through April 2000 utilizing the following keywords: estrogen, progesterone, oral contraceptives, hormonal replacement therapy, esophagus, stomach, peptic ulcer disease, gallbladder, irritable bowel syndrome, colon, inflammatory bowel disease, ischemic colitis and arteriovenous malformations. This review provides an abundance of data supporting that estrogen and progesterone have both beneficial and detrimental effects on the esophagus, stomach, gallbladder, and small and large intestine.

Digestive System↗
PubMed1999

The effect of medroxyprogesterone acetate on angiogenesis in complex endometrial hyperplasia.

OBJECTIVE: To evaluate the effect of orally administered medroxyprogesterone acetate upon angiogenesis in the myometrium of patients with complex endometrial hyperplasia. METHODS: Microvessel counts in the myometrium of consecutive patients with complex endometrial hyperplasia, treated with oral medroxyprogesterone acetate prior to hysterectomy (n = 12), were compared with microvessel counts of consecutive control patients with complex endometrial hyperplasia without prehysterectomy medroxyprogesterone acetate treatment (n = 15). All specimens were stained immunohistochemically for factor VIII-related antigen as a sensitive and specific marker for vascular endothelium. Areas with the highest angiogenic intensity, within the myometrium immediately underlying complex endometrial hyperplasia, were selected. Three fields (x400) were selected for each slide, and the mean microvessel count per high-power field was calculated. Statistical analysis included factorial analysis of variance/covariance, and multiple regression analysis with P < 0.05 considered significant throughout. RESULTS: Microvessel counts of uterine specimens of patients with complex endometrial hyperplasia treated with oral medroxyprogesterone acetate were significantly lower than microvessel counts of control patients with complex endometrial hyperplasia without medroxyprogesterone acetate therapy (median 20, range 11-37 versus median 38, range 20-130, respectively, P < 0.001). CONCLUSION: Orally administered medroxyprogesterone acetate has a significant antiangiogenic effect upon myometrium immediately underlying complex endometrial hyperplasia.

Administration, Oral↗
PubMed1999

Angiogenesis in malignancies of the female genital tract.

OBJECTIVE: The purpose of this work was to review current knowledge pertaining to angiogenesis in malignancies of the female genital tract. METHODS: We identified studies published in the English language regarding angiogenesis in gynecologic malignancies. The studies were obtained from a MEDLINE search from 1966 through June 1998; additional sources were identified through cross-referencing. RESULTS: A growing body of evidence confirms the ability of vulvar and cervical squamous cell carcinomas and endometrial and ovarian adenocarcinoma to induce angiogenesis. In vulvar intraepithelial neoplasia a correlation between vascular endothelial growth factor (VEGF) expression, microvessel density (MVD), and progression of dysplasia has been demonstrated. In invasive vulvar carcinoma, high VEGF expression and MVD portend poor prognosis. Currently a debate exists regarding the ability of cervical squamous intraepithelial neoplasia to induce angiogenesis. Most studies, however, indicate angiogenesis to be of prognostic value in patients with invasive squamous cell carcinoma. The ability of complex endometrial hyperplasia to induce angiogenesis has been demonstrated. A direct correlation between angiogenesis, higher grade and depth of invasion in Stage I adenocarcinoma, and prognostic value in Stage I and II and recurrent disease has been noted. In ovarian epithelial adenocarcinoma, higher microvessel counts in the primary ovarian tumor or omental metastases may serve as a prognostic indicator for survival. CONCLUSIONS: Similar to other malignant diseases, angiogenesis appears to play an important role in disease progression and survival in patients with gynecologic malignancies. Preliminary data indicate angiogenesis may serve as a prognostic indicator in vulvar and cervical squamous cell carcinomas and endometrial and ovarian adenocarcinomas. These findings may lead to future application of therapeutic trials with antiangiogenic factors.

Adenocarcinoma↗
PubMed1999

Pleomorphic rhabdomyosarcoma of the uterus in a postmenopausal woman with elevated serum CA125.

BACKGROUND: Pure rhabdomyosarcoma of the uterus is an exceedingly rare tumor. While there are no commonly associated tumor markers, a previously reported case confirmed CA125 production by a pure uterine rhabdomyosarcoma. CASE: We describe a postmenopausal woman who presented with vaginal bleeding and was diagnosed with pleomorphic rhabdomyosarcoma of the uterus. Of particular interest was an elevated serum CA125 level at presentation. Immunohistochemical staining with CA125 antibody, however, showed no activity within the tumor. Despite aggressive therapy, the patient experienced distant nodal metastases and succumbed to the disease within 25 months of diagnosis. CONCLUSION: Our patient illustrates the typical presentation and aggressive behavior of this rare neoplasm. While serum CA125 may be a useful tumor marker in selected patients, elevated levels do not directly reflect tumor burden when associated with negative immunohistochemical staining.

CA-125 Antigen↗
PubMed1999

The efficacy of cervical conization in the treatment of cervical intraepithelial neoplasia in HIV-positive women.

OBJECTIVE: The aim of this study was to evaluate the efficacy of cervical conization in the treatment of CIN in HIV-positive women. MATERIALS AND METHODS: Sixty-six HIV-positive women treated with cervical conization for CIN were stratified into four groups based on surgical margin and endocervical curetting (ECC) status (group 1: -margin/-ECC, group 2: +margin/-ECC, group 3: +margin/+ECC, group 4: -margin/+ECC). The rate of histologically proven recurrent CIN was calculated for each group and compared using chi(2) analysis. The effect of +margins, +ECC, degree of dysplasia, and CD4 count on the risk of recurrence was determined by logistic regression. RESULTS: Forty-nine percent of patients with negative margins and negative ECC experienced recurrence, most within 36 months. There was no significant difference in recurrence rate for patients with positive margins (69.2%, P = 0.19), positive ECC (50%, P = 0.97), or positive margins and ECC (66.7%, P = 0.41) when compared to patients with complete excision of dysplasia. No significant difference in the mean CD4 count of patients with and without recurrent dysplasia (316 vs. 390 cells/mm3, P = 0.37) was observed. Logistic regression showed only degree of dysplasia in the cone specimen to have a marginally significant linear relationship with recurrence. CONCLUSION: Cervical conization is not an effective method for eradicating CIN in HIV-positive women. Most patients will recur despite complete excision of dysplasia. Surgical margin status, ECC status, and CD4 count appear to have no effect on recurrence rate. Although multiple procedures were necessary in some patients, cone biopsy was effective in preventing progression to invasive cervical cancer in all cases.

Adult↗
PubMed1999

The significance of ASCUS cytology in HIV-positive women.

OBJECTIVE: The aim of this study was to determine the incidence and severity of dysplasia associated with a cytologic diagnosis of atypical cells of undetermined significance (ASCUS) in women infected with the human immunodeficiency virus (HIV). METHODS: A cross-sectional analysis of cervical cytology, colposcopic impression, and cervical biopsy results was performed on 261 HIV-positive women diagnosed with ASCUS. The prevalence and grade of histologically documented cervical intraepithelial neoplasia (CIN) was determined. Patients with CD4 counts above and below 200 cells/mm(3) were compared using chi(2) analysis to determine any effect of worsening immunosuppression on the rates of associated dysplasia. RESULTS: Seven hundred sixty-one Pap smears were performed during the study period. Two hundred nine (27%) were diagnosed as ASCUS. All patients (pts) received colposcopic evaluation. The incidence of human papilloma virus (HPV) effect, low-grade CIN (I), and high-grade CIN (II, III, and carcinoma in situ) documented by cervical biopsy, cervical conization or endocervical curettings was 40, 17, and 15%, respectively. No cases of invasive cancer were found. These results are similar to those of previous cytohistologic studies of ASCUS in HIV-untested populations. There was no significant difference in frequency or severity of CIN in pts with severe immunosuppression (P = 0.4). CONCLUSION: A cytologic diagnosis of ASCUS in HIV-positive women identifies a group at significant risk for histologic abnormalities. The majority of pts will be diagnosed with HPV or low-grade CIN. HIV infection and severe immunosuppression do not appear to increase the frequency or severity of CIN associated with ASCUS. Given the 32% risk of associated CIN, all HIV-positive women with ASCUS cytology should undergo colposcopic evaluation.

Adult↗
PubMed1999

Malignant transformation of an ovarian mature cystic teratoma presenting as a rectal mass.

BACKGROUND: Squamous cell carcinoma arising from malignant degeneration of a mature cystic teratoma is rare with a reported incidence of approximately 1-3%. The most common presenting symptoms are lower abdominal pain and increasing abdominal girth of several months' duration. Approximately 50% of the patients present with FIGO stage I while 35-38% present with stage III diseases. CASE: The case described herein represents an unusual presentation and initial diagnostic dilemma of locally aggressive squamous cell carcinoma arising in an ovarian dermoid cyst, with invasion into the distal rectum and anal canal causing rectal bleeding similar to the presentation of anal squamous cell carcinoma. Despite aggressive surgical management with posterior exenteration and optimal tumor debulking followed by 5040-cGy pelvic radiation utilizing 25-MV photons, the patient developed pelvic recurrence at the vaginal cuff 6 weeks after completion of her adjuvant radiotherapy. She subsequently failed cis-platinum single-agent chemotherapy and died 9 months after her initial surgery and diagnosis. CONCLUSION: Squamous cell carcinoma in the anal canal, diagnosed by colonoscopy or proctoscopy, could be an unusual presentation of that arising from malignant degeneration of an ovarian dermoid cyst. This tumor may behave in a locally aggressive manner and be resistant to pelvic radiation or single-agent chemotherapy of cis-platinum. The current experience of adjuvant treatment after comprehensive staging and cytoreductive surgery reported in the world literature is limited, and the optimal management of the malignancy remains unclear.

Adult↗
PubMed1999

Angiogenesis of the endometrium.

OBJECTIVE: To present current data pertaining to angiogenesis of the endometrium throughout the normal menstrual cycle and in benign and neoplastic diseases of the endometrium. SOURCES: We conducted a computerized search of MEDLINE, Current Contents, and Index Medicus for relevant studies in the English literature published between January 1966 and October 1998. STUDY SELECTION: We reviewed all studies that included human and animal models of angiogenesis of normal cyclic endometrium and benign and neoplastic endometrial diseases. TABULATION, INTEGRATION, AND RESULTS: Angiogenesis is important to cyclic, regenerating endometria and disease processes including dysfunctional uterine bleeding, response to exogenous hormonal treatment, bleeding associated with intrauterine contraceptive devices, uterine leiomyomata, endometriosis, complex endometrial hyperplasia, and endometrial carcinoma. CONCLUSION: In the future, knowledge of specific angiogenic patterns of various disease processes might improve application of antiangiogenic medications in therapies for benign and neoplastic diseases of the endometrium.

Carcinoma↗
PubMed1999

Transabdominal application of transvaginal transducer enhancing depiction of mature cystic teratoma at 34 weeks' gestation.

We present an unusual case in which a 36-year-old patient was referred for consultation due to increasing upper left abdominal pain at 35 weeks' gestation. Transabdominal ultrasonography disclosed an appropriate-for-gestational-age singleton, vertex-presenting fetus with normal anatomy. An unclear, complex, semisolid, semicystic mass was noted in the upper right abdomen. Due to the close proximity of the adnexal mass to the patient's abdominal wall, a high-frequency transvaginal transducer was applied transabdominally. Unlike the unclear images generated at conventional transabdominal ultrasonography, this application depicted a discrete mass with multiple characteristics consisting of calcifications, hair and fatty tissue, considered diagnostic of a mature cystic ovarian teratoma. The patient delivered spontaneously at 39 weeks' gestation. At 6 weeks' postpartum an elective laparotomy left ovarian cystectomy was performed and a mature cystic teratoma confirmed by pathology examination.

Abdomen↗
PubMed1999

Automated cervical cytology: meta-analyses of the performance of the PAPNET system.

UNLABELLED: Our objective was to assess current knowledge regarding PAPNET (Neuromedical Systems, Inc.) automated cervical cytology screening methods and to assess the performance of this automated system in comparison with manual screening. To this goal, studies published in the English language regarding the PAPNET system, identified from a MEDLINE search through August 1998 were selected. Performance of the PAPNET system was assessed with various meta-analysis techniques, using the method of Mantel-Haenszel. In the primary screening modality, meta-analysis of the performance of the PAPNET system indicates that when compared with manual screening, the odds of obtaining a positive result were significantly greater. The Mantel-Haenszel odds ratio for combined studies was 1.19 (95 percent CI = 1.13 to 1.26, P < .001), corresponding to 20 percent greater odds of positive or suspicious slides with PAPNET system. The PAPNET system performs with almost two-fold less false-negative results. The Mantel-Haenszel odds ratio for combined studies was 0.41 (95 percent CI = 0.25 to 0.67, P < .005). Applied as a quality control modality rescreening all consecutive previously manually screened negative slides, depending on study design, the PAPNET system reclassified as abnormal between 0.1 and 5 percent. However, when the PAPNET system was used to rescreen known false-negative slides, PAPNET system rescreening can correctly identify between 20 and 90 percent of manually screened false-negative slides with an average reduction of 33 percent of the manually screened false-negative slides. We conclude that compared with manual screening, PAPNET identifies 20 percent more abnormal, has two-fold less false-negative, and reclassifies as abnormal one third of manually screened false-negative slides. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to understand how the PAPNET system works and what is its approved use by the FDA, and to understand the associated benefits and shortcomings of the PAPNET system when compared with the traditional screening method.

Cost-Benefit Analysis↗
PubMed1999

Automated cervical cytology: meta-analyses of the performance of the AutoPap 300 QC System.

The objective of this study was to review current knowledge regarding the performance of the AutoPap 300 QC System (NeoPath Inc., Redmond, WA) for automated cervical cytology screening. To this goal, we identified all studies published in the English language that included the AutoPap 300 QC automated cervical cytology system. The studies were obtained from a MEDLINE search through October 1998; additional sources were identified through cross-referencing. Studies concerning the AutoPap 300 QC System containing complete data are presented descriptively. Meta-analyses about the performance of the AutoPap 300 QC System were performed. The central goal of the meta-analyses was to estimate the overall false-negative rate of the AutoPap 300 QC System when applied in either of the two following modalities: primary screening and quality control. Of the 14 studies concerning the performance of the AutoPap 300 QC System as a primary screening modality, four studies provided complete data about the number of abnormal slides, review rate, and number of slides selected. Meta-analysis of these four studies indicate sensitivities ranging between 85 and 100 percent. Regarding the performance of the AutoPap 300 QC System in the quality control modality, of the 14 studies reviewed, 5 studies provided complete data including the number of false-negatives, review rate, and number of slides selected. Meta-analysis of these five studies indicate an average sensitivity of the AutoPap 300 QC System applied as a rescreening modality of 37 percent (95% CI; 34-40 percent), with observed salvage ratios of between 3.5 and 5.6 when review rate of the AutoPap 300 QC System was set at 10 percent.

Female↗
PubMed1999

Management of pelvic abscess during pregnancy: a case and review of the literature.

UNLABELLED: Cases of pelvic or abdominal abscess complicating pregnancy are rare. Noninvasive diagnostic techniques including ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) have enabled early diagnosis of this unusual complication of pregnancy. We describe a patient in whom the diagnosis of a pelvic mass was made by sonography and MRI at 25 weeks' gestation. At laparotomy, a pelvic abscess was partially resected and drained. Two weeks later when the patient again became symptomatic, a recurrent pelvic abscess was detected by CT and treated with intravenous antibiotics and CT-guided transcatheter drainage. The patient's recovery was thereafter uncomplicated and she delivered a healthy male infant by elective repeat cesarean at 38 weeks' gestation. The literature concerning pelvic and abdominal abscesses during pregnancy is reviewed. The potential advantages of imaging-guided, percutaneous transcatheter drainage for the treatment of such patients are emphasized. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to understand the nonsurgical alternatives for the drainage of intraabdominal abscesses, the possible etiologies of intraabdominal abscess formation in the pregnant population, and the various approaches to percutaneous catheter drainage of intraabdominal abscesses.

Abscess↗
PubMed1999

Transcatheter uterine artery embolization for the management of symptomatic uterine leiomyomas.

UNLABELLED: Transcatheter arterial embolization has been applied traditionally in obstetrics and gynecology for the emergency control of pelvic hemorrhage, usually after failure of conventional surgical measures. Pelvic trauma is the most common, nongynecologic etiology of uncontrollable pelvic hemorrhage requiring use of this hemostatic technique. Recently, elective transcatheter arterial embolization of uterine leiomyomas has been performed to decrease related symptomatology in an attempt to avoid surgical intervention. Our objective was to review current pertinent data regarding this new therapeutic modality. To this goal, all manuscripts published in the literature regarding this topic obtained from a MEDLINE search for 1966 through September 1998 were selected and reviewed. Additional sources were identified through cross-referencing. Currently, approximately 193 patients worldwide have been managed with this investigational procedure. Main indications include symptomatic uterine leiomyomata with menometrorrhagia, anemia, or pain. Success rates seem promising with a very low failure rate. This procedure results in significant (uterine and leiomyoma) volume reduction of between 20 and 80 percent. Postprocedural pain is common during the first day after the procedure, often requiring intravenous nonsteroidal antiinflammatory drugs and narcotic analgesia. Rare complications include endometritis, pyometra, and uterine necrosis, which may require hysterectomy. Reported follow-up time ranges between 6 and 60 months. Implications on subsequent fertility have not been established. Although successful pregnancies subsequent to this procedure have been reported, because of the unknown long-term effect of this procedure on fertility or perinatal outcome, this technique should not be performed when future fertility is desired. This review suggests that although not currently accepted as standard of care, transcatheter embolization of the uterine arteries can be considered as a nonsurgical technique for the management of appropriately selected patients. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to explain the current indications and contraindications of transcatheter uterine artery embolization of leiomyomas; to identify the various complications of the procedure and the type of embolic materials used; and to estimate the success rate of this procedure in the current literature.

Adult↗