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Biomedical subjects

B L Harlow

Publications and source records attributed to B L Harlow.

At least 19 recordsLinked to original sources
PubMed1992

The role of cytoreductive surgery in the management of stage IV epithelial ovarian carcinoma.

Patients with Stage IV epithelial ovarian carcinoma are generally treated in the same manner as are patients with disease confined to the abdomen--cytoreductive surgery followed by combination chemotherapy. Between 1980 and 1990, 35 women with histologically or cytologically documented Stage IV ovarian carcinoma were treated in this fashion. Sixteen women (45%) underwent optimal initial cytoreductive surgery, defined as less than 2 cm maximum residual disease. Eleven of the 19 women undergoing suboptimal initial procedures underwent interval cytoreduction after two to four cycles of chemotherapy, with 7 achieving an optimal status after the interval procedure. Overall, 23 of 35 patients (66%) were successfully cytoreduced to less than 2 cm either initially or at an interval procedure. Thirty-one of the 35 patients received combination regimens containing platinum as part of their initial therapy. Kaplan-Meier survival curves demonstrated no significant difference in survival between those groups of women cytoreduced intervally or initially, or between those groups of women optimally cytoreduced at some point during their initial therapy and those who were not. The 5-year survival for the entire group was less than 5%, with no significantly prolonged survival seen in those patients undergoing successful cytoreduction.

Chemotherapy, Adjuvant↗
PubMed1992

Evidence of embryo- and trophoblast-toxic cellular immune response(s) in women with recurrent spontaneous abortion.

OBJECTIVE: The purpose of this study was to determine whether reproductive antigens stimulate lymphocytes and macrophages from women with recurrent abortion to secrete factors that are toxic to preimplantation embryos or trophoblast cells in vitro. STUDY DESIGN: Mononuclear cells were isolated from 30 fertile controls and 300 nonpregnant women being evaluated for recurrent abortion. Supernatants generated from these cells after separate culture with sperm and trophoblast antigen extracts were added to two-cell mouse embryo cultures and trophoblast proliferation assays. Toxicity was assumed when the median percentage of embryos developing to blastocysts or trophoblast proliferation was less than or equal to 50% of control values. Both parametric and nonparametric statistical methods were used where appropriate. RESULTS: Mouse embryo development and/or trophoblast proliferation were significantly inhibited by supernatants from trophoblast and/or sperm antigen-activated peripheral blood leukocyte cultures from a majority of 300 women with recurrent abortion but not from 30 women with normal reproductive histories. The mouse blastocyst development assay was more sensitive than the trophoblast proliferation assay in determining toxic factor production. Embryo-toxic factors were produced by activated leukocyte cultures from 90% of 180 women with a history of recurrent abortion of unexplained etiology, whereas trophoblast-inhibitory factors were detected in 50% of women from the same group. The embryo-toxic factor(s) was heat labile, had a molecular weight(s) between 10 and 30 kd, and was absorbed out by passage through affinity columns containing anti-interferon gamma beads. CONCLUSION: We conclude that recurrent abortion in some women is associated with embryo- and/or trophoblast-toxic factor production in response to stimulation by sperm or trophoblast antigens and that the principal factor may involve the 18 kd, heat-labile, T-lymphocyte cytokine interferon gamma. This study suggests a new cause of recurrent abortion.

Abortion, Habitual↗
PubMed1992

Perineal exposure to talc and ovarian cancer risk.

OBJECTIVE: We sought to determine whether the use of talc in genital hygiene increases the risk for epithelial ovarian cancer. METHODS: We interviewed 235 white women diagnosed with epithelial ovarian cancer between 1984-1987 at ten Boston metropolitan area hospitals and 239 population-based controls of similar race, age, and residence. RESULTS: Overall, 49% of cases and 39% of controls reported exposure to talc, via direct application to the perineum or to undergarments, sanitary napkins, or diaphragms, which yielded a 1.5 odds ratio (OR) for ovarian cancer (95% confidence interval [CI] 1.0-2.1). Among women with perineal exposure to talc, the risk was significantly elevated in the subgroups of women who applied it: 1) directly as a body powder (OR 1.7, 95% CI 1.1-2.7), 2) on a daily basis (OR 1.8, 95% CI 1.1-3.0), and 3) for more than 10 years (OR 1.6, 95% CI 1.0-2.7). The greatest ovarian cancer risk associated with perineal talc use was observed in the subgroup of women estimated to have made more than 10,000 applications during years when they were ovulating and had an intact genital tract (OR 2.8, 95% CI 1.4-5.4); however, this exposure was found in only 14% of the women with ovarian cancer. CONCLUSIONS: These data support the concept that a life-time pattern of perineal talc use may increase the risk for epithelial ovarian cancer but is unlikely to be the etiology for the majority of epithelial ovarian cancers.

Adult↗
PubMed1991

The influence of lactose consumption on the association of oral contraceptive use and ovarian cancer risk.

The authors investigated the joint effects of diet and oral contraceptive use on ovarian cancer risk in 194 white women aged 65 years or less with epithelial ovarian cancer and 193 age- and residence-matched controls in Boston between 1984 and 1987 by using in-person interviews and self-administered food frequency questionnaires. Use of oral contraceptives for 3 months or more was associated with a modest protective effect for ovarian cancer (odds ratio (OR) = 0.7, 95 percent confidence interval (CI) 0.5-1.1). In women who consumed 11 g or less per day of lactose, use of oral contraceptives for 3 months or more was associated with a nonsignificant increased risk (OR = 1.6, 95 percent CI 0.8-3.2). In women who consumed more than 11 g per day of lactose, use of oral contraceptives for 3 months or more was associated with a substantially decreased risk of ovarian cancer (OR = 0.3, 95 percent CI 0.1-0.7). Within this group, the strongest association occurred with more than 4 years of total oral contraceptive use (OR = 0.2, 95 percent CI 0.1-0.6) and in those who had more than 2 years of oral contraceptive use after age 30 years (OR = 0.1, 95 percent CI 0.03-0.4). These results suggest that, with respect to ovarian cancer, lactose users may be the most likely to benefit from oral contraceptive use and that the benefit may be strongest when oral contraceptive use occurs after age 30 years.

Adult↗
PubMed1991

Small sac size in the first trimester: a predictor of poor fetal outcome.

A nonbradycardiac fetal heart rate is associated with a low rate of spontaneous abortion (2%-4%). To determine criteria for predicting impending first-trimester loss when a normal fetal heart rate is identified sonographically, the authors studied 16 consecutively examined patients with pregnancies of 5.5-9 weeks gestation, a small sac size, and fetuses with normal cardiac activity. Mean sac size (MSS) was determined and a small sac was diagnosed when the difference between the MSS and crown-rump length (MSS--CR) was less than 5 mm. Fifty-two consecutively examined patients with pregnancies of 5.5-9 weeks gestation, normal sac size, and fetuses with normal heart rate formed the control group. An MSS--CR of 5 mm or greater was considered normal. Fifteen of the 16 patients (94%) with first-trimester small sacs had spontaneous abortions despite normal sonographic cardiac activity. Four of the 52 control patients (8%) with normal sac sizes had spontaneous abortions. The authors' data show that, despite the presence of fetal cardiac activity at the time of sonography, the usual reassurance provided to patients should be guarded when the sac size is small.

Abortion, Spontaneous↗
PubMed1991

Spontaneous preterm birth: a case-control study.

Information on demographic characteristics, life-style, and reproductive, prenatal, and medical history was obtained from the prenatal records of 140 women with a preterm delivery (cases) and 280 women with a term delivery (controls) matched by age. Compared with controls, a greater proportion of cases were nonwhite, never married, and educated less than 12 years. When logistic regression was used to control for confounding variables, a number of risk factors were found to be associated with an increased risk for preterm delivery: a history of a prior preterm delivery (relative risk, 3.5; confidence interval, 1.6 to 7.8), smoking during the pregnancy (p value test of trends, 0.005), and a prepregnancy weight less than 61.5 kg (relative risk, 2.0; 95% confidence interval, 1.2 to 3.2). Seven (5%) cases and none of the controls indicated a history of maternal diethylstilbestrol exposure (p less than 0.001). A history of prior induced abortion was associated with a modest increase in risk for a spontaneous preterm delivery (relative risk, 1.6; confidence interval, 0.9 to 2.7), and this risk increased with increasing numbers of induced abortions (p value for chi 2 test of trend, 0.02).

Abortion, Induced↗
PubMed1990

Plasma alpha-L-fucosidase activity and the risk of borderline epithelial ovarian tumors.

The authors obtained venous blood samples from 106 female residents of western Washington in whom serous and mucinous borderline ovarian tumors had been diagnosed between 1980 and 1985 ("cases") and from a randomly selected telephone sample of 134 control women from the same counties. Mean activity in plasma of alpha-L-fucosidase was slightly higher in cases (334 units/ml) compared to controls (306 units/ml). The risk for a serous borderline tumor was virtually the same for women in all four quartiles of alpha-L-fucosidase activity. Women in the three lowest quartiles of activity were at 50-70% the risk of women in the highest quartile for the development of a mucinous tumor, but within these three quartiles there was no trend of decreasing risk with decreasing activity. These results suggest that for most women plasma alpha-L-fucosidase activity has little or no bearing on the risk of borderline ovarian tumors. Whether such an association exists in women genetically predisposed to these tumors could not be assessed.

Adenocarcinoma, Mucinous↗
PubMed1990

Hypoplasia of the middle phalanx of the fifth digit. A feature of the second trimester fetus with Down's syndrome.

It has been established that 60% of infants with Down's syndrome have hypoplasia of the middle phalanx of the fifth digit. To determine whether this would be a useful prenatal sonographic sign for Down's syndrome, we measured the middle phalanx of the fifth and fourth digits in 1,032 fetuses between 15 and 20 weeks gestational age at the time of amniocentesis, prior to any knowledge of the karyotypes. A ratio of the middle phalanx of the fifth digit over the middle phalanx of the fourth digit was calculated, and the median ratio for the 1,024 normal fetuses was 0.85. There were eight fetuses who had trisomy 21 by karyotype and their median ratio was 0.59 (P = .04). Of the eight fetuses with Down's syndrome, seven had ratios below the normal population median. If an arbitrary cut-off point is used at a ratio of 0.70, 6/8 (75%) of those with Down's syndrome would be identified, as well as 18% of normal fetuses (positive predictive value = 3.2% in this group). Although we do not suggest that this ratio be used alone as a screening test for Down's syndrome, these findings confirm the presence of a small middle phalanx in fetuses with trisomy 21 as early as 15 to 16 weeks and may be a useful adjunct to the several already reported sonographic signs in the fetus at risk for Down's syndrome.

Down Syndrome↗
PubMed1990

Fetal pyelectasis: a possible association with Down syndrome.

Two hundred ten consecutive fetuses were identified as having renal pyelectasis among 7400 patients scanned during 1 year. Seven of these 210 fetuses had Down syndrome. We reviewed images of the kidneys of 44 fetuses with Down syndrome collected over 5 years and found that 25% of these affected fetuses had pyelectasis. The incidence of Down syndrome was 3.3% when fetal pyelectasis was present.

Amniocentesis↗
PubMed1989

Galactose consumption and metabolism in relation to the risk of ovarian cancer.

In a case-control study, consumption of dairy foods by 235 white women with epithelial ovarian cancer and by 239 control women, and activity of red blood cell galactose-1-phosphate uridyl transferase (transferase) in a subset of 145 cases and 127 controls were determined. Yogurt was consumed at least monthly by 49% of cases and 36% of controls. The mean transferase activity of cases was significantly lower than that of controls. When a ratio of lactose consumption to transferase (L/T) was calculated, cases had a mean L/T of 1.17 compared with 0.98 for controls; there was a highly significant trend for increasing ovarian cancer risk with increasing L/T ratio. Lactose consumption may be a dietary risk factor and transferase a genetic risk factor for ovarian cancer.

Adult↗
PubMed1989

Galactose-1-phosphate uridyl transferase activity associated with age at menopause and reproductive history.

Reproductive history was obtained and the activity and electrophoretic pattern of the blood enzyme galactose-1-phosphate uridyl transferase (transferase) was measured in 104 adult Caucasian women, less than 70 years of age, sampled from the general population. Fifteen women were identified as carriers for the Duarte (GtD) or galactosemia (gt) variants of transferase--genes associated with reduced transferase activity compared with normal (Gt+). The mean age at menopause for 8 women with a natural menopause who were GtD/Gt+ or gt/Gt+ was 44.8, significantly younger (P = 0.007) than the mean age of 49.2 reported by 31 naturally postmenopausal subjects with Gt+/Gt+ genotypes and normal transferase activity. Compared with the latter group, women who were Duarte or galactosemia carriers were 13.7 times more likely to have a menopause before age 48 (with 95% confidence limits of 2.0 to 95.5). Six of 13 (46%) married women who were GtD/Gt+ or gt/Gt+ reported more than 2 years' trying to achieve a pregnancy, compared with 11 of 74 (15%) with normal genotypes and activity (P = 0.02). The authors conclude that genetic deficiency of transferase may be associated with infertility and early menopause.

Adult↗
PubMed1989

A case-control study of borderline ovarian tumors: the influence of perineal exposure to talc.

The authors interviewed 116 female residents of western Washington State with serous and mucinous borderline ovarian tumors diagnosed between 1980 and 1985 and questioned them on their use of hygienic powders. A sample of 158 control women from the same counties were identified through random digit dialing and were interviewed as well. Neither the perineal application of baby powder nor the perineal application of cornstarch was associated with an appreciably altered risk of borderline ovarian tumors. However, women who used deodorizing powders alone or in combination with other talc-containing powders had 2.8 times the risk (95% confidence interval 1.1-11.7) of women who had not had perineal exposure to powder. These results suggest that future studies of ovarian tumors in relation to the application of talc-containing powders should consider ascertaining the specific type(s) of powder used.

Adult↗
PubMed1989

Sonographic evaluation of hydrops fetalis.

Sonographic criteria were developed to aid in determining the cause of hydrops fetalis in 26 consecutive cases diagnosed antenatally. This enabled us to predict whether the hydrops was due to anemia-related causes (isoimmunization, fetomaternal hemorrhage, alpha-thalassemia) or non-anemia-related causes. Fetuses without anemia as the cause of hydrops most often exhibited pleural effusions (87%) or marked edema (62.5%). A combination of pleural effusions and marked edema was evident in fetuses without anemia 56.3% of the time. Those with anemia as the cause of hydrops were significantly less likely to exhibit pleural effusions (20%), marked edema (10%), or pleural effusions and marked edema (10%). A thickened placenta occurred significantly more frequently (80 versus 37%) in anemia-associated hydrops. With the use of cordocentesis and intravascular in utero transfusion, the early recognition and treatment of hydrops fetalis due to anemia should lead to improved outcome in fetuses so affected.

Anemia↗
PubMed1988

Case-control study of borderline ovarian tumors: reproductive history and exposure to exogenous female hormones.

Borderline ovarian tumors possess many of the same morphological features as their malignant counterparts, but they do not destructively invade the ovarian stroma, and the women in whom they develop generally have a favorable prognosis. Female residents of three urban counties of western Washington diagnosed with serous and mucinous borderline ovarian tumors between 1980 and 1985 (n = 116) were interviewed regarding past reproductive events. A random sample of women from the same counties (n = 158) was identified through random digit dialing and were interviewed. The risk of these ovarian tumors among women who had given birth to 1 or 2 children and to 3 or more children was, respectively, 0.7 and 0.4 that of nulliparous women. There was no consistent influence of increasing age at first live birth. Adjusting for parity, a history of lactation was associated with a 50% reduction in risk. Among nulliparous women, a further increase in risk was present in those who reported a history of infertility. Use of oral contraceptives was associated with a 60% reduction in risk. However, the size of the association was not dependent on duration, age at first use, or years since last usage. In conclusion, borderline tumors appear to have similar epidemiological patterns with regard to reproductive events as their more malignant counterparts.

Adult↗
PubMed1988

Two one-step methods for household screening and interviewing using random digit dialing.

Random digit dialing is commonly used to select controls for epidemiologic studies. The traditional method of random digit dialing entails screening households to obtain a pool of eligible subjects and then selecting a random sample to serve as controls. Two random digit dialing methods are described in which household screening and interviewing are combined into one step. The advantages and limitations associated with both of the one-step methods and the traditional two-step approach are discussed.

Data Collection↗
PubMed1987

Epidemiology of borderline ovarian tumors.

Ovarian tumors of low malignant potential, often termed "borderline tumors," have been defined as those that have some but not all of the morphologic features of malignancy (i.e., they are not invasive). With the use of data obtained by the western Washington population-based Cancer Surveillance System for 1975-83, the incidence of serous and mucinous borderline epithelial ovarian tumors was analyzed, as well as the survival of women who developed them. The incidence of borderline tumors increased with increasing age, although at a pace somewhat slower than that of malignant ovarian tumors. There was an upward trend in the incidence of borderline tumors starting in the late 1970's, a trend not present for malignant tumors. Only 12% of borderline tumors were not confined to the ovary, as opposed to 40% of malignant Grade I and 73% of other malignant ovarian neoplasms. At 5 years following diagnosis, the survival of women with borderline tumors was 93% that of the general female population. This percentage varied little by stage or histologic type. Given the reduced survival of women with these ovarian tumors and the lack of a sharp histologic distinction between borderline and Grade I malignant lesions, it is recommended that borderline ovarian tumors be routinely ascertained by population-based cancer registries.

Adenocarcinoma, Mucinous↗