Biomedical subjects
Publications and source records attributed to R Yazigi.
Three cases of breast cancer that metastasized to the uterine cervix are presented. A review of the literature disclosed 21 additional cases. Seventy-five percent of the patients presented with abnormal vaginal bleeding, 62% had no gross evidence of malignancy on examination, and in 89% the cervical metastases were a manifestation of widespread disease.
Surgical staging, consisting of peritoneal washings for cytology, infracolic omentectomy, and biopsies of diaphragm, extrapelvic peritoneum, and pelvic and aortic lymph nodes, was performed in 29 patients with ovarian tumors of low malignant potential, presumed to be either Stage I (25) or Stage II (4), in order to determine the incidence of unsuspected metastases in patients with localized disease. Fourteen patients had all and fifteen patients had one or more of these procedures performed. Overall, in stages I and II, positive peritoneal cytology was found in 7%, unexpected omental metastases in 13%, diaphragmatic metastases in 7%, positive pelvic lymph nodes in 27%, and positive aortic lymph nodes in 7%. Seven out of 29 (24%) patients with presumed localized disease, were upstaged by virtue of the staging procedures. Based on our findings, we conclude that surgical-pathologic staging to search for occult metastases in ovarian tumors of low malignant potential is justified from an investigational standpoint: however, its impact on therapeutic management is far from being defined.
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Persistent pulmonary hypertension of the neonate, a disease of unknown etiology, is associated with a mortality rate as high as 50%. We conducted a retrospective study (1979-1983) to identify antenatal events that may be associated with this disease. Thirty-seven mothers of neonates with this disorder were compared with 150 randomly selected control patients. Logistic regression analysis revealed that meconium, maternal fever (caused by urinary tract infection, upper respiratory infection, chorioamnionitis, and unknown causes), maternal anemia (caused by abruptio placentae, placenta previa, and unknown causes), and maternal pulmonary disease (caused by asthma and/or pneumonia) were associated with persistent pulmonary hypertension of the neonate. The computed odds ratios for the variables associated with this disease were increased significantly above the controls. In addition, cesarean section, nonvertex presentation, fetal distress, and vaginal bleeding were found to be significant on univariate analyses. The cesarean section rate in the study group was 59%, with the primary indications of fetal distress and/or third-trimester bleeding in 77.3% of instances. These data suggest that antenatal risk factors and the computed odds ratio may help identify pregnancies likely to produce infants at high risk for persistent pulmonary hypertension of the neonate.
An unusual case of pregnancy complicated by intraabdominal sarcoma is presented; tumor reductive surgery was required late in the second trimester so that a gestational age of fetal viability could be reached. Fetal outcome was successful. The mother died shortly after delivery. Management of widespread intraabdominal cancer complicating the latter half of pregnancy should aim toward obtaining fetal viability.
Thyrotropin releasing hormone (TRH) readily crosses the placenta and stimulates the fetal pituitary. We studied the response of the maternal and fetal pituitary-thyroid axes to TRH and the influence of prenatal exposure to TRH on the physiological postnatal increase in thyrotropin (TSH) and triiodothyronine (T3) in the neonate. Twenty-six pregnant women received TRH (400 or 600 micrograms) intravenous or saline (controls) either 2 or 12 h before elective cesarean section at term. Administration of 400 micrograms of TRH resulted in significant elevations of maternal TSH (15.7 +/- 2.9 versus 3.2 +/- 0.4 microU/ml, p less than 0.01) and prolactin (416 +/- 94 versus 223 +/- 41 ng/ml, p less than 0.05) 2 h later. Maternal T3 remained unchanged. A higher dose of TRH (600 micrograms) produced comparable results. Maternal administration of TRH (400 micrograms) 2 h before delivery resulted in significant increases in fetal TSH and T3 over controls (21.1 +/- 3.7 versus 4.8 +/- 1.0 microU/ml, and 132 +/- 12 versus 64 +/- 9 ng/dl, p less than 0.01, respectively). Cord blood hormone levels 12 hours after TRH administration were similar to controls. Higher doses of TRH did not produce further increases in fetal TSH or T3. Control and treated neonates demonstrated similar physiological postnatal increases in TSH and T3, suggesting that prior exposure to TRH did not blunt this response. These data suggest that maternal administration of TRH is an effective way of increasing fetal T3 levels, and that this treatment does not inhibit the postnatal surge in TSH and T3.
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To determine the efficacy of ifosfamide in the treatment of advanced ovarian malignancy, 20 patients with stages III and IV epithelial ovarian cancer were treated with this agent. Of these, 15 received the drug as primary chemotherapy. The response rate was 33%, with a median duration of remission of 13 months. Five patients were treated with ifosfamide after failure with previous chemotherapy; no responses were seen in this group. Hematuria was observed in 2% of the treatment cycles with the use of the antidote mercapto-ethan-sulfonate acid. This study shows that though ifosfamide is an active drug in the treatment of patients with advanced ovarian cancer, it is not superior to traditional single alkylating agents.
The distribution and heterogeneity of cholecystokinin (CCK) in different regions of the central nervous system (CNS) of 12 adult rats and six cows was determined by means of specific radioimmunoassays. In addition, the biologic activity of immunoreactive material was evaluated in a bioassay that used a rabbit gallbladder-strip preparation. High amounts of immunochemically detectable CCK-8 (20.2 +/- 1.5 pmol/g) and CCK-33 (33.7 +/- 3.3 pmol/g) and of biologically active CCK were found in the telencephalon, although concentrations decreased progressively from the rostral to the caudal portions of the brain. The distribution and biologic activity of CCK was similar in rat and cow brain. Ratios of biologic to immunologic activity ranged from 1.0 to 8,0 and were higher for CCK-8 than for CCK-33. The results indicate that (1) CCK-8 and CCK-33 immunoreactivity are widely distributed throughout the CNS in a unique and differential manner; (2) CCK is biologically active in all the regions of the brain, with a pattern of distribution similar to that found with radioimmunoassay; (3) measurable bioactivity was equal to or greater than measurable immunoreactivity in all areas of the brain in rat and cow; and (4) CCK is present in tissues without significant species differences between rat and cow.
Ninety-seven patients admitted for diagnostic curettage of peri- and postmenopausal bleeding underwent cytologic evaluation by the endocyte technique in order to test the accuracy of the method. Six patients with endometrial carcinoma were diagnosed by curettage and in five of them the cytologic specimens correctly agreed with histology; the other case was an inadequate sample for cytologic diagnosis. Hyperplastic endometrium was found in 14 cases by curettage; only three of them had been detected by cytology. This cytologic technique proved to be satisfactory in diagnosing endometrial cancer but inadequate for detection of premalignant lesions.
The prognostic significance of malignant peritoneal cytology was evaluated in 93 patients with stage I endometrial cancer seen at Roswell Park Memorial Institute. Eighty-three patients (89%) had negative cytologic samples and ten (11%) had positive cytology for neoplastic cells. All patients were followed for a minimum of ten years or until dead from cancer or intercurrent disease. No patient received treatment for positive cytology. There was one recurrence in the patients with positive cytology (10%), and six recurrences in the negative group (7%). The actuarial survival rate at five and ten years for patients with negative cytology was 93.9 and 92.5%, respectively. For patients with positive cytology, the survival was 87.5% at both time intervals. No significant difference was found between the groups. Malignant peritoneal cytology does not seem to be a prognostic indicator in stage I endometrial cancer.
This study was undertaken to investigate the mechanism by which the small intestine removes circulating gastrin and cholecystokinin (CCK). A 100-cm (acute study, 10 dogs) or a 50-cm (chronic study, 5 dogs) segment of midjejunum was excluded in all 15 dogs. The excluded loop was perfused with 0.1 M phosphate buffer (pH 7.4), which was constantly recirculated by a peristaltic pump. It the acute control study (5 dogs), gastrin concentrations in the intestinal perfusate were increased gradually to a level of 320 +/- 49 pg/ml at 90 min (i.e., 7.6 +/- 0.9 times higher than serum gastrin levels). In the antrectomy group (5 dogs), perfusate gastrin concentrations were greatly decreased after antrectomy, in consonance with the decrease in serum gastrin concentrations. In the chronic study (5 dogs), perfusate gastrin concentrations were significantly increased after food stimulation, in consonance with the increase in serum gastrin concentrations. CCK was also released into the bowel lumen in considerable amounts basally and after endogenous release. Although one cannot exclude the possibility that a considerable amount of gastrin or CCK in the lumen may originate from the bowel segment, this study shows that the small bowel removes gastrin and CCK from the circulation by their secretion into the bowel lumen. Loss of this mechanism might partially explain the rise in gastrin levels that is observed in some patients after extensive small bowel resections.
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The effects of pentagastrin on acid secretion, short circuit current, electrical conductance and potential difference were determined in isolated bullfrog fundic mucosa. Biologically active luminal pentagastrin had no effect on gastric mucosa, even at a concentration 100 times higher than that necessary for stimulation of the mucosa from the serosal side. It is concluded that luminal gastrin does not appear to have a physiologic role in gastric secretory processes.
Seventeen women with metastatic uterine sarcomas were treated with Adriamycin chemotherapy. Only one (6%) had an objective response. In addition, 12 patients with early uterine sarcomas were randomized to Adriamycin versus no adjuvant chemotherapy in order to evaluate the effect of Adriamycin in reducing the incidence of subsequent distant recurrences. Of those women receiving Adriamycin, two developed distant metastasis and two developed life-threatening congestive heart failure. Also, two of the six women who did not receive Adriamycin developed distant metastasis. Therefore, continuation of the randomized trial was considered unjustified.