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Biomedical subjects

A Fishman

Publications and source records attributed to A Fishman.

At least 73 records · Page 4Linked to original sources
PubMed1996

Ovarian tumors of low malignant potential. Correlation of DNA index and S-phase fraction with histopathologic grade and clinical outcome.

BACKGROUND: DNA ploidy and/or S-phase fraction have been used as biologic predictors of aggressive behavior in a variety of solid tumors, including ovarian carcinomas. Recently, attention has focused on borderline lesions to determine if flow cytometry plays a role in separating potentially aggressive tumors from those which will pursue a more innocuous course. METHODS: Paraffin-embedded tissue from 42 tumors with low malignant potential (LMP) were analyzed by flow cytometry (FC) to determine the DNA index (DI) and S-phase fraction (SPF). These result were then correlated with conventional pathologic parameters (size, nuclear grade, architecture, and mitotic index) and with clinical parameters (stage and age). Statistical analysis was carried out using the Fisher's Exact and Kruskal-Wallis tests. RESULTS: Thirty-five cases (83.3%) were diploid, while 7 cases (16.7%) showed aneuploid stemlines, with a mean DI of 1.2 (range: 1.1-1.4). The mean SPF was 3.5% for the diploid tumors and 4.5% for the aneuploid tumors. Serous tumors comprised 74% of our cases; the remainder were either mucinous or endometrioid tumors. Complex solid architectural patterns were found in 29 tumors whereas high nuclear grade was seen in 24. A mitotic rate (MR) of 0-3/10 high power fields was seen in 29 tumors (69%), with only 5 having 10 or more mitotic figures. Aneuploidy statistically correlated with higher stage (P < 0.009). Marginal correlation was seen with a larger tumor size (P = 0.06). SPF showed a direct linear correlation with MR (P < 0.001). Also, smaller SPF's were seen in the serous tumors versus the mucinous and endometroid group (P < 0.05). Two patients with diploid and one patient with aneuploid stemlines had recurrent disease during the follow-up period. CONCLUSIONS: DI and SPF correlated with some of the histologic parameters we evaluated. DI and SPF, however, could not predict which tumor(s) would behave in a more aggressive fashion.

Adult↗
PubMed1996

Polyserositis as an unusual sign of methotrexate toxicity.

We present a 46-year-old patient who underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy for persistent trophoblastic disease. Single-agent chemotherapy with alternate methotrexate 1 mg/kg/day and leucovorin 0.1 mg/kg for 8 days was instituted on the first postoperative day. Various adverse symptomatology developed, culminating in a unique side effect, polyserositis. To the best of our knowledge, the wide spectrum of side effects, the short time lapse after onset of chemotherapy, and their severity are uncommon in a patient receiving her first chemotherapeutic treatment with MTX.

Antimetabolites, Antineoplastic↗
PubMed1996

How frequently should the amniotic fluid index be performed during the course of antepartum testing?

OBJECTIVE: Our purpose was to evaluate the need for frequent amniotic fluid volume assessments in our antepartum testing unit. STUDY DESIGN: In a retrospective analysis of data accumulated over 1 year in our antepartum testing unit amniotic fluid index values performed at 3- to 4-day intervals were compared with follow-up values. Of 11,827 amniotic fluid index values, there were 6291 with follow-up values within 4 days. The results were stratified on the basis of the subsequent amniotic fluid index value and estimated gestational age. Comparisons were made relating to amniotic fluid index testing intervals of 4 versus 7 days. RESULTS: Patients with an amniotic fluid index > 8 cm had a 2.3% chance (128/5677) of having oligohydramnios (amniotic fluid index < or = 5.0 cm) in the next 4 days. Those patients with low-normal amniotic fluid index values (5 to 8 cm) had a 16.2% chance (96/593) of having oligohydramnios in the next 4 days. There were few patients with an amniotic fluid index < or = 5 cm who had subsequent amniotic fluid index values measured. Patients with an amniotic fluid index > 8 cm had a 2.2% chance (156/6946) of having oligohydramnios within 7 days, and those with low-normal amniotic fluid index values had a 16.3% chance (105/643) of having oligohydramnios with 7 days. Stratifying the results by gestational age reveals that patients at > or = 41 weeks of gestation had a 23.3% chance of having oligohydramnios within 4 days if the current amniotic fluid index was found to be 5 to 8 cm and a 7.4% chance if the current amniotic fluid index was found to be normal. Term (estimated gestational age of 37 to 40 weeks) patients had a similar risk of oligohydramnios in 4 days if the amniotic fluid index was low-normal (17.8%) but a risk of 3.6% if the amniotic fluid index was normal. CONCLUSIONS: For patients at < 41 weeks of gestation undergoing antepartum testing, weekly assessments of amniotic fluid index is probably adequate if the initial measurement is in the normal range (> or = 8 cm) because the risk of having oligohydramnios within 7 days is low (2.2%). For patients at < 41 weeks of gestation whose initial amniotic fluid index measurement is in the low-normal range (5 to 8 cm), a scheme of twice-weekly assessment is justified on the basis of a higher risk for an amniotic fluid index < or = 5 cm within 4 days (12.3%). For all patients at > or = 41 weeks of gestation, twice-weekly amniotic fluid index assessments are recommended regardless of the initial measurement.

Amniotic Fluid↗
PubMed1996

Malignant tumors arising in endometriosis: clinical-pathological study and flow cytometry analysis.

BACKGROUND: Malignant transformation to endometriosis is a well documented phenomenon that occurs most commonly in the ovaries with cancer arising in extra-ovarian endometriosis being a rare event. METHODS: A retrospective clinical-pathological evaluation of eleven cases with malignant tumors arising in endometriosis was performed to evaluate the prognostic impact of various factors. Nuclear DNA content (ploidy) was assessed through flow cytometric study. RESULTS: Ovarian origin was identified in eight cases and three were associated with extra-ovarian endometriosis. Histologic type was endometrioid carcinoma in ten patients. The eleventh case had high grade endometrial stromal sarcoma. All tumors were diploid with no relation to stage, grade, or clinical outcome. The S-phase fraction (SPF) was analyzed in nine patients and no correlation could be demonstrated with any histologic parameters or clinical outcome. CONCLUSIONS: The DNA content seems to have no association with the classical prognostic parameters in these cases.

Adult↗
PubMed1996

Preliminary report of the activity of docetaxel in advanced or recurrent squamous cell cancer of the cervix.

Eighteen patients with squamous cell cancer of the cervix were treated with i.v. docetaxel 100 mg/m2 over 1 h every 21 days. No patient received prior chemotherapy, except as a radiation sensitizer. Median age was 42 years (range 30-58) and Zubrod performance status was 1 (0-2). Ten (59%) patients had prior surgery and 11 (65%) had prior radiation therapy. Sixteen patients were evaluable for response. Two patients had a partial response (13%; 95% CI 0-32%) and eight (50%; 95% CI 23-77%) had stable disease. Dose reduction to 75 mg/m2 was required in 10 patients and to 55 mg/m2 in one patient. Granulocytopenia was the major hematopoietic toxicity (31% grade 3 and 44% grade 4). Docetaxel is active in patients with squamous cell cancer of the cervix and may be tolerable at this dose schedule.

Adult↗
PubMed1996

Laparoscopic epiplopexy of the greater omentum and epiploic appendices in the salvaging of dysfunctional peritoneal dialysis catheters.

The success of peritoneal dialysis in the management of chronic renal failure depends on the proper function of the implanted catheter. Common causes of catheter drainage dysfunction include an omental wrap or blockage of the catheter by other intraperitoneal structures. The present report describes laparoscopic management of five patients with outflow obstruction of a peritoneal dialysis catheter. Epiplopexy of the greater omentum or epiploic appendices was employed in all cases to prevent potential recurrence of catheter dysfunction. Technique and other procedural details are described. Long-term successful function of the peritoneal dialysis catheter was restored in all patients.

Catheters, Indwelling↗
PubMed1996

Aggressive fibromatosis of the female pelvis. A case report and review of the literature.

Aggressive fibromatoses (desmoid tumors) are rare tumors of fibroblastic origin that may arise in any musculoaponeurotic structure with a propensity of infiltrate adjacent tissues, but not to metastasize. Tumors of musculoaponeurotic origin are seldom encountered by the gynecologist. A case of pelvic fibromatosis is reported together with a discussion of theories of etiology and management options.

Adult↗
PubMed1996

Leuprolide acetate for treating refractory or persistent ovarian granulosa cell tumor.

OBJECTIVE: To evaluate leuprolide acetate for treating refractory or persistent ovarian granulosa cell tumor (GCT). STUDY DESIGN: We treated six patients who had recurrent or persistent ovarian GCT with monthly intramuscular injections of a depot formulation of leuprolide acetate, 7.5 mg. Four patients had received prior cisplatin-based chemotherapy. Initially these patients' tumors had responded to the cisplatin, but then the disease had progressed in all cases. One of these four patients also had received prior therapy with tamoxifen that had resulted in three months of stable disease. Two patients had received no prior chemotherapy. RESULTS: Responses could be evaluated in five of the six patients; in the sixth patient, only survival was evaluable. Among the five evaluable patients, two achieved partial responses lasting 3 and 11 months, with disease progression-free intervals of 4 and 12 months. The other three patients (60%; 95% confidence interval [CI], 20-95%), including two whose disease had progressed on chemotherapy, had stable disease with disease progression-free intervals of 3+, 3+ and 13+ months. The objective response rate was 40% (two of five patients; 95% CI, 10-90%). Cessation of disease progression was noted in all five of the evaluable patients (100%; 95% CI, 40-100%). The sixth patient, whose disease could not be evaluated, was treated with leuprolide acetate for 24 months and at this writing had no clinical evidence of disease. The therapy was convenient to administer, and no major side effects were noted. Leuprolide acetate thus appears to have activity in patients with refractory GCT, and it may prolong the disease progression-free interval. Further trials of this relatively nontoxic and convenient therapy are warranted.

Adult↗
PubMed1996

Low molecular heparin (Enoxaparin) as an alternative treatment of acute deep venous thrombosis in gynecologic oncology patients.

While heparin has been the standard treatment in established deep vein thrombosis (DVT), it carries associated potential hazards of hemorrhage and induction of thrombocytopenia. Enoxaparin (Rhone-Poulenc Rorer Pharm. Inc., France) is a low molecular weight heparin which has antithrombotic properties, and has been demonstrated effective in prophylaxis of DVT, apparently without severe treatment related bleeding complications. Six patients with genital malignancies, presenting with Doppler sonography confirmed deep venous thrombosis, were treated with Enoxaparin. A uniform dosage of 2 mg/kg/day in two divided doses was administered subcutaneously for 10 days during hospitalization and then continued on an out-patient basis. The clinical symptoms of venous thromboses diminished in all six patients. Enoxaparin represents an effective treatment of DVT, with the potential advantage of a lessening hemorrhagic complications. With administration of low molecular heparin, the activated partial thromboplastin time (aPTT) is not dramatically altered, making laboratory monitoring unnecessary. Our clinical findings demonstrate an easily applied therapy for gynecologic oncology patients, which is potentially safer to use, less costly, and less dependent on laboratory monitoring than the normal regimen.

Adult↗
PubMed1995

Carboplatin reinduction after taxane in patients with platinum-refractory epithelial ovarian cancer.

PURPOSE: To determine the activity of carboplatin in patients with ovarian cancer who progressed on taxane (paclitaxel or docetaxel) therapy. PATIENTS AND METHODS: Thirty-three patients with ovarian cancers refractory to platinum and taxane therapy were treated with single-agent carboplatin reinduction once the disease progressed on a taxane. The starting dose of carboplatin was 300 mg/m2 at 28-day intervals. RESULTS: Patients were a median age of 56 years (range, 31 to 80), had a median Zubrod performance status of 1 (range, 0 to 2) and had received a median of three prior chemotherapy regimens (range, two to eight) and one pretaxane platinum regimen (range, one to three). Twenty-six patients had a platinum-free interval of at least 12 months at the time of posttaxane re-treatment with carboplatin. There were seven of 33 (21%) partial responses, with a median duration of 7+ months (range, 2+ to 12+). Responses were noted only in patients with at least a 12-month platinum-free interval and an initial sensitivity to a taxane. The therapy was well tolerated and neurotoxicity was absent. CONCLUSION: A subset of patients with platinum-refractory disease that initially responded to a taxane and who eventually have a platinum-free interval of at least 1 year may respond to carboplatin reinduction. This finding may be secondary to paclitaxel or docetaxel therapy that leads to the reversal of platinum resistance, or the prolonged platinum-free interval permits the loss of resistance to platinum by the tumor. Carboplatin reinduction should be considered in the treatment of patients whose ovarian cancer progresses after an initial sensitivity to a taxane and who had a prolonged platinum-free interval.

Adult↗
PubMed1995

Aggressive angiomyxoma of the pelvis and perineum. A case report.

BACKGROUND: Aggressive angiomyxoma of the female perineum and pelvis is a slowly growing neoplasm occurring almost exclusively in women of reproductive age. The tumor is characterized by its locally infiltrative behavior. The high recurrence rate has been attributed to incomplete surgical excision. CASE: A case of a huge, recurrent, aggressive angiomyxoma of the perineum and pelvis was treated. CONCLUSION: Correct preoperative diagnosis and assessment of simultaneous perineal and pelvic involvement indicate a combined abdominoperineal surgical approach to achieve wide, tumor-free margins.

Adult↗
PubMed1994

Increased cytotoxicity of interleukin 2-pseudomonas exotoxin (IL2-PE) chimeric proteins containing a targeting signal for lysosomal membranes.

IL2-PE40 is a chimeric protein composed of human interleukin 2 (IL2) genetically fused to the amino terminus of a truncated form of pseudomonas exotoxin lacking its cell recognition domain (PE40). IL2-PE40 is extremely cytotoxic to IL2 receptor positive cells. This chimeric protein was found to be an effective and selective immunosuppressive agent for IL2 receptor targeted therapy in many models of disorders of the immune response where activated T-cells play a crucial role. In an attempt to produce an improved IL2-PE40 chimeric protein, we constructed new IL2-PE derivatives. This was done by inserting defined DNA sequences within the chimeric gene encoding IL2-PE40. Inserted sequences represent motifs of other proteins known to be targeted and/or sorted to specific compartments inside or outside the cell. One of the proteins, IL2-PE40(LAP+DUP), containing a targeted signal for lysosomal membrane, was 2-3-fold more active than IL2-PE40. The insertion of the LAP sequence also increased the cytotoxicity of another IL2-PE derivative, IL2-PE664Glu. Our results suggest that a selective targeting of IL2-PE chimeric proteins to lysosomes may enable the proteins to reach the cytosol more efficiently, thus improving its specific cytotoxicity. The LAP (lysosomal alkaline phosphatase) sequence may be used as a common motif for increasing the cytotoxicity of other chimeric proteins to be used for targeted immunotherapy.

ADP Ribose Transferases↗
PubMed1994

Second primary cancer arising from the neovulva following reconstruction with myocutaneous flaps.

Myocutaneous flaps have been used for vulvar reconstruction following radical vulvectomy. For over 15 years the most common complications related to these flaps are sloughing of the skin and donor site wound infection. A new malignancy arising from the skin of the neovulva is an unusual occurrence. Two cases are presented. The skin of the neovulva may be exposed to the same neoplastic carcinogens that caused the initial lesion. In both patients, the polymerase chain reaction method failed to detect the presence of human papillomavirus DNA in either the initial lesion or the recurrent cancer.

Aged↗
PubMed1994

Solitary breast metastasis as first manifestation of ovarian carcinoid tumor.

Carcinoid tumor metastatic to the breast is very uncommon. The rarity of this finding may be the reason for its common misinterpretation as primary breast carcinoma. A patient with primary ovarian carcinoid that presented initially with a solitary breast mass is reported. A review of the literature discloses only 12 reported cases of carcinoid tumor metastatic to the breast, with none of the primaries found to be the ovary.

Breast Neoplasms↗
PubMed1994

Retrograde ejaculation due to heterotopic erectile tissue.

We report a case of retrograde ejaculation due to an unusual prostatic urethral mass. The resected tissue was histologically indistinguishable from corpus spongiosum, and due to its location it was diagnosed as heterotopic erectile tissue. The embryological origin of this lesion is discussed.

Adult↗