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Biomedical subjects

A D Nicastri

Publications and source records attributed to A D Nicastri.

At least 19 recordsLinked to original sources
PubMed2001

Cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma.

OBJECTIVE: To examine the association between cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma. METHODS: Fifty-four patients diagnosed by cone biopsy with stage I cervical carcinoma and treated with radical hysterectomy comprised the study group. The association between the depth of invasion on conization, lymph-vascular invasion, positive cone margins, positive endocervical curettage (ECC), and the depth of residual invasion in the radical hysterectomy specimen was examined using Pearson r and point biserial correlation. Independent predictors of the depth of residual invasion were determined by multiple regression. RESULTS: The depth of residual invasion correlated significantly with the depth of invasion (r =.374) and presence of lymph-vascular invasion (r(pb)=.372) in the conization specimen, post-cone ECC status (r(pb) =.669), and age at diagnosis (r =.347). The same factors were jointly assessed using multiple regression (R(2) =.636, P<.001). Depth of invasion on conization, lymph-vascular invasion, and ECC status were identified as independent predictors of the depth of residual invasion. Patients with deep (5 mm or greater) stromal invasion and lymph-vascular invasion on conization had significantly higher rates of positive parametrial margins (22% compared with zero, P =.001) and adjuvant radiation (66.7% compared with 20%, P =.004) compared with all other patients. CONCLUSION: Depth of invasion, presence of lymph-vascular invasion, and age at diagnosis were independent predictors of the depth of residual invasion in the subsequent hysterectomy specimen. These factors should be considered in treatment planning. Patients with a combination of these factors may have increased risk for deep residual invasion, positive hysterectomy margins, and adjuvant radiation.

Carcinoma, Squamous Cell↗
PubMed1995

Acute interstitial nephritis associated with ticlopidine.

Ticlopidine, a platelet aggregation inhibitor, has been approved to decrease the risk of thrombotic stroke. We describe a 75-year-old white woman who developed acute renal failure 10 days after initiating ticlopidine therapy. A renal biopsy revealed interstitial infiltrates containing lymphocytes and eosinophils. To our knowledge this is the first report of ticlopidine-induced acute interstitial nephritis.

Acute Kidney Injury↗
PubMed1994

Intrauterine pregnancy coincident with endometrial carcinoma: a case study and review of the literature.

A case of endometrial adenocarcinoma discovered incidentally in a patient who underwent an elective abortion is described here. Eleven other cases of pregnancy occurring with endometrial carcinoma were found in the literature. The presence of immature progesterone unresponsive endometrium is discussed as a possible etiology of the unusual coincidence of these two common phenomena.

Abortion, Induced↗
PubMed1994

Myoepithelial carcinoma of the breast with distant metastasis and accompanied by adenomyoepitheliomas.

A breast tumour in a 47-year-old female with axillary lymph node metastasis was interpreted as the rare malignant adenomyoepithelioma based on morphological and immunohistochemical studies. Multiple bone metastases developed and the patient died after 7 months. The malignant neoplasm consisted of cords and interlacing bundles of spindle cells with indistinct cell borders and clear cytoplasm. The cells stained positively for cytokeratin, S-100 protein, GFAP, and muscle-specific actin, and possessed basal lamina, pinocytic vesicles, tonofilaments, desmosomes, and intermediate filaments with dense bodies. In some areas, cells with microvillous projections enclosed small spaces. In the breast, foci of myoepithelioma with various morphological subtypes and infiltration coexisted, demonstrating the origin of the malignant tumour. The histogenesis of the myoepithelial tumours is discussed.

Biopsy↗
PubMed1990

Mucoepidermoid carcinoma of uterine cervix stage IB. Long-term follow-up, histochemical and immunohistochemical study.

Twelve women with mucoepidermoid carcinoma of the cervix uteri were followed for 2-15 years after diagnosis. Three patients died within 14 months. All had lymph node metastases and/or vascular involvement and exhibited tumor invasion to a depth of 1.2-3.2 cm. Mucoepidermoid carcinoma is defined as a tumor with the appearance of squamous cell carcinoma without any glandular pattern and with demonstrable intracellular mucin. The mucin is best demonstrated by alcian blue and periodic acid-Schiff-diastase. In 265 cases of squamous cell carcinoma, stage IB, lymph node metastases were present in 14%. In the cases of mucoepidermoid carcinoma, the prevalence of nodal metastases was 33%. Because mucoepidermoid carcinomas appear to be more aggressive lesions than squamous cell carcinomas are, it may be advisable to stain all cervical squamous carcinomas for mucin if they demonstrate finely vacuolated cytoplasm and lack peripheral palisading. Immunohistochemical studies for carcinoembryonic antigen (CEA), keratin, and epithelial membrane antigen were positive in all tumors to varying degrees. The detection of CEA may be of additional help in establishing a diagnosis.

Adult↗
PubMed1987

The types of renal disease in the acquired immunodeficiency syndrome.

Between January 1982 and December 1986, among the 750 patients with the acquired immunodeficiency syndrome (AIDS) who were treated at two adjacent hospitals in New York City, 78 (10.4 percent) needed evaluation for renal disorders. Reversible acute renal failure due to nephrotoxic injury, ischemic injury, or both was present in 23 patients (30 percent) (Group I). The remaining 55 (70 percent) had massive proteinuria, azotemia, or both (AIDS-associated nephropathy; Group II), and irreversible uremia developed in 43. In an additional 18 patients, all of whom had a history of intravenous narcotic drug use, AIDS was diagnosed after the initiation of maintenance hemodialysis for chronic renal failure (Group III). Survival for more than six months after the onset of chronic uremia occurred in only two subjects in Group II; all patients in Group III died within three months of the diagnosis of AIDS. Death in the patients in Groups II and III followed a syndrome of "failure to thrive" characterized by inanition unresponsive to intensive nutritional support and hemodialysis. In contrast, 8 of 17 patients with acute renal failure (Group I) and a serum creatinine concentration above 6 mg per deciliter regained renal function (serum creatinine level, less than 2.0 mg per deciliter). Four of the seven lived for 10 to 24 months, whereas the other four died of sepsis within a month. Our observations suggest that maintenance hemodialysis is not effective in prolonging life either in patients with AIDS-associated nephropathy and uremia or in patients with end-stage renal failure in whom AIDS develops during the course of maintenance dialysis. Hemodialysis may be useful in the management of potentially reversible acute renal failure in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Granular juxtaglomerular cell hyperplasia caused by cyclosporine.

Histologic study of kidneys from rabbits given cyclosporine (CsA) revealed a marked hyperplasia of granular cells in the juxtaglomerular (JG) apparatus, but without a significant increase in the total cell number of JG cells. The increase in granular JG cells as compared with the control group was 204% and 406% for 30 mg/kg alternate days and 30 mg/kg daily groups, respectively. The increases for the lower-dosage groups were much smaller, although the increases were statistically significant for all but the 10 mg/kg alternate-days group. Other studies suggest that sympathomimetic activity of CsA may be the mechanism involved in granular JG cell hyperplasia.

Animals↗
PubMed1985

Prognostic factors in malignant mesodermal (mullerian) mixed tumors of the uterus.

Clinicopathologic studies of 16 homologous and 19 heterologous malignant mesodermal (Mullerian) mixed tumors of the corpora uteri showed that homologous tumors were more common in black women than in white women; in the former, tumors were diagnosed at a younger age and in more advanced stages than in the latter. Fifty-five percent of women with clinical stage I disease had a higher surgicopathologic stage. The most significant prognostic factors were pathologic extent of disease and vascular invasion in the myometrium. There was no difference in outcome between homologous and heterologous tumors. Initial surgery for staging is essential for the adequate evaluation and treatment of these patients.

Aged↗
PubMed1985

Prognostic factors in carcinoma of the vulva.

The clinical and pathologic characteristics of epidermoid carcinoma of the vulva in 84 women treated by vulvectomy were evaluated in relation to inguinal node status and survival. Tumor diameter, depth of invasion, clinical node status, vascular invasion, and pattern of invasion were all individually correlated with the pathologic status of the inguinal nodes. However, when evaluated in combination, only the clinical status of the inguinal nodes, the depth of invasion, and the pattern of invasion (in this order of significance) were predictive of pathologic inguinal node status. Tumor diameter, inguinal node status, depth of invasion, pattern of invasion, and vascular invasion were individually correlated with survival. When evaluated in combination, the clinical diameter of the lesion was the most important predictor of survival; depth of invasion and vascular invasion contributed additional information.

Carcinoma, Squamous Cell↗
PubMed1984

Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome.

Of the 92 patients with the acquired immunodeficiency syndrome (AIDS) who were seen at our institution over a two-year period, 9 acquired the nephrotic syndrome (urinary protein greater than 3.5 g per 24 hours) and 2 had azotemia with lesser amounts of urinary protein. Five of these 11 patients had a history of intravenous-heroin addiction, but in the remaining six, there were no known predisposing factors for nephropathy. In nine patients (including the six non-addicts) the course of renal disease was marked by rapid progression to severe uremia. Renal tissue examined by biopsy in seven patients and at autopsy in three revealed focal and segmental glomerulosclerosis with intraglomerular deposition of IgM and C3. In the 11th patient, renal biopsy revealed an increase in mesangial matrix and cells, with deposition of IgG and C3 consistent with a mild immune-complex glomerulonephritis, and severe interstitial nephritis. We conclude that focal and segmental glomerulosclerosis may be associated with AIDS and suggest that rapid deterioration to uremia may characterize this renal disease.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Vascular invasion in Stage I carcinoma of the cervix.

Vascular invasion was identified as an important prognostic variable for all lesion sizes in 138 patients with Stage I cervical carcinoma. A matched pairs analysis, controlling for lesion size and extracervical spread, showed that vascular invasion was significantly associated with poor outcome. Regression analysis also indicated that vascular invasion contributed prognostic information beyond that available from lesion size and extracervical spread. Studies of adjunctive therapy based on the prognostic variables are recommended.

Carcinoma↗
PubMed1983

Lupus nephritis in black and Hispanic children.

We studied the long-term outcome of lupus nephritis in 23 black and Hispanic children. The follow-up period ranged from two to 16.5 years, with a mean follow-up of 5.4 years. The mean age at onset was 10.1 years, which is younger than that described in recent series of children with lupus nephritis. All patients had renal involvement, including four normotensive patients with normal renal function and normal urinary sediment. When children whose disease started before the age of 10 years were compared with patients older at onset, there were no significant differences regarding the type of lesion or duration of therapy, but a higher incidence of renal death (.02 less than P less than .05) was noted in younger children. Overall, 25% of our patients have died of renal causes, and another 25% have been undergoing dialysis, receiving transplants, or in chronic renal failure. The mortality in our series was higher than that reported in other series of children with lupus nephritis in recent years. Age and race may be acting synergistically to produce the higher mortality and morbidity.

Age Factors↗
PubMed1983

Long-term evaluation of children with nephrotic syndrome and focal segmental glomerular sclerosis.

We studied the long-term outcome of a group of children with the nephrotic syndrome who showed the histological lesion of focal segmental glomerular sclerosis (FSGS) during the course of their illness. Of 25 such children studied, a complete follow-up ranging from 3 to 19 years was available in 24. Two distinct groups could be identified. Patients in the first group were characterized by steroid resistance (SR) from the onset, whereas those in the second group were initially steroid sensitive (SS), and had the histological lesion of minimal change which, over time, evolved into FSGS. SR patients had a mean age of 7.7 +/- 3.7 years compared to SS patients who were 3.5 +/- 2.5 years old (p less than 0.01). There were more females (11 of 14) in the SR group than in the SS group (3 of 10; p less than 0.02). The incidence of hematuria was higher in the SR patients (9 of 14) than SS patients (2 of 10; p less than 0.05). SR patients also exhibited a greater degree of growth retardation at the end of the follow-up period (9 of 13 compared to 1 of 8 SS patients; p less than 0.02). SR patients reached end-stage renal failure earlier (2.3 +/- 1.3 years) than SS patients (10 +/- 5.8 years; p less than 0.01) after the initial biopsy. Of the 13 kidney transplanted into 9 SR patients, recurrence of FSGS was noted in two allografts. Of the 4 kidneys transplanted into 2 SS patients, recurrence was seen in 1. The overall recurrence rate of FSGS in allografts was 17.6%. Our study suggests that the two varieties of FSGS occurring in nephrotic patients may be distinct nosologic entities rather than a single disease with varied manifestations.

Adolescent↗
PubMed1981

Breast self-examination, relationship to stage of breast cancer at diagnosis.

Data from 996 newly diagnosed breast cancer patients indicated a highly significant association (P less than 0.001) between periodic breast self-examination (BSE) and pathologic stage of disease. Among women reporting periodic BSE, only small differences were noted between those who practiced monthly and those who practiced several times annually. Average maximum tumor diameter and frequency of tumors 4 cm or large were significantly greater (P less than 0.01) among women who rarely or never practiced BSE. The relationship between the periodic practice of BSE and the diagnosis of breast cancer before nodal involvement was present even after controlling for a wide variety of variables. The regular practice of BSE was associated with a one-third reduction in the likelihood of diagnosis of disease with positive nodes. This difference translated to a 10% decline in five-year mortality for whites and a 17% decline for nonwhites.

Adult↗
PubMed1981

5-fluorouracil/chemosurgery for intraepithelial neoplasia of the lower genital tract.

Sixteen patients with lower genital intraepithelial neoplasia were treated by 5-fluorouracil (5-FU)/chemosurgery: colposcopically directed excision of neoplastic epithelium pretreated with topical 5-FU. 5-FU loosens the neoplastic epithelium, facilitating its removal from the underlying stroma in a safe, minimally traumatic fashion. 5-FU/chemosurgery was undertaken in patients with vaginal neoplasia or those with lower genital neoplasia who were immunosuppressed or had a neoplastic syndrome, because conventional methods are often difficult or inadequate for these problems. In all 16 patients, the neoplasia went into remission. Two immunosuppressed patients developed recurrences of lesser dysplasia when 5-FU maintenance therapy was interrupted because of pregnancy. It was found that 5-FU/chemosurgery, followed by monthly 5-FU maintenance, may be the best treatment for intraepithelial neoplasia of the vagina or lower genital intraepithelial neoplasia in patients who are immunosuppressed or have a neoplastic syndrome.

Adult↗