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D P Goldstein

Publications and source records attributed to D P Goldstein.

At least 19 recordsLinked to original sources
PubMed1992

A flow cytometric study of 137 fresh hydropic placentas: correlation between types of hydatidiform moles and nuclear DNA ploidy.

Hydropic placentas may be classified by histopathology into hydropic abortus, partial hydatidiform mole, and complete hydatidiform mole. We studied 142 hydropic placentas: 39% were complete hydatidiform moles, 35% partial hydatidiform moles, and 26% hydropic abortuses. Villous vesicle size was predictive of histologic diagnosis. We determined DNA ploidy in 137 cases. Seventy-three percent of hydropic abortuses were diploid and 11% were triploid. Ninety percent of partial moles were triploid or near-triploid; one partial mole was haploid and one diploid. Of the complete moles, 50% were diploid, 43% were tetraploid, 3.6% polyploid, and 1.7% triploid. Partial moles had lower pre-evacuation beta-hCG levels than complete moles. Persistent tumor followed 33% of complete moles and 12% of partial moles. Although the numbers were small, no patient with a diploid, tetraploid, aneuploid, or haploid partial mole developed persistent disease. Among complete moles, the pre-evacuation beta-hCG level was not predictive of persistence (P = .15). Subdividing complete moles by ploidy, we found that tetraploid moles were associated with higher pre-evacuation beta-hCG levels than were diploid moles. However, tetraploidy was not associated with increased persistent tumor among complete moles. Although most partial moles were triploid and most complete moles were diploid or tetraploid, there was wider DNA heterogeneity among molar gestations than previously reported. In this series, DNA ploidy was not an independent predictor of persistence in complete moles.

Adolescent↗
PubMed1992

Probe tube systems: effects of equalization on real ear insertion and aided gain.

In probe tube measures, the method used to equalize the sound field will determine the reference value used in calculating real ear insertion gain (REIG) and real ear aided gain (REAG). Several equalization methods are available with current probe tube systems. This study determined the effects of three equalization methods (substitution, modified comparison, and ipsilateral comparison) on REIG and REAG measures using open and closed earmolds for ear canals varying in circumference. Twelve subjects were selected representing a wide range of ear canal circumferences. Results revealed significant differences for REIG and REAG among the three equalization methods. These differences appear to be due to the different acoustic components included or excluded for each method. The results of this study suggest that the sound field equalization method used for probe tube measures needs to be considered when interpreting the hearing aid gain reported among various probe microphone units. Also, canal circumference may be a quick method for categorizing canal cavity size and appears to influence measured hearing aid gain.

Adult↗
PubMed1991

Flow cytometric analysis of DNA content in partial hydatidiform moles with persistent gestational trophoblastic tumor.

Hydatidiform moles may be classified as partial or complete based on genetic and pathologic criteria. Between January 1979 and January 1990, 17 (5.5%) of 310 patients followed for partial mole developed persistent gestational trophoblastic tumor. Tissues from 14 partial moles were available for flow cytometric analysis of DNA content. Eleven partial moles (85%) were triploid, two (15%) were diploid, and one DNA histogram was uninterpretable. All patients with triploid partial moles achieved complete remission with one course of single-agent chemotherapy. The two with diploid partial mole required multiple courses of chemotherapy to achieve gonadotropin remission. Although the DNA content of most partial moles with persistent gestational trophoblastic tumor was triploid, diploid partial moles with persistent tumor were less sensitive to single-agent chemotherapy.

DNA, Neoplasm↗
PubMed1991

Pathologic features of sharp curettings in complete hydatidiform mole. Predictors of persistent gestational trophoblastic disease.

The medical records and pathologic specimens were reviewed from 33 patients with complete molar pregnancy at Brigham and Women's Hospital between 1980 and 1989. Two pathologists (D.R.G. and R.W.R.) reviewed all slides from the original sharp curettage to identify pathologic features that may be associated with persistent gestational trophoblastic tumor (GTT). The pathologic features evaluated were implantation site, presence of myometrium, presence of villi, presence and degree of atypia in cytotrophoblast, syncytiotrophoblast and intermediate trophoblast, presence of fibrinoid, presence of implantation site inflammatory cells, volume of tissue and area of trophoblastic tissue. Only one pathologic feature, fibrinoid deposits, identified in sharp curettings was associated with the development of persistent GTT. While 12 (48%) of 25 patients who attained remission without chemotherapy had fibrinoid deposits, only 1 (12.5%) of 8 patients who developed persistent GTT had them (P less than .10).

Adult↗
PubMed1991

Management of low-risk metastatic gestational trophoblastic tumors.

The clinical course of 48 patients with low-risk metastatic gestational trophoblastic tumors (GTTs) treated with primary single-agent chemotherapy was reviewed. All patients achieved sustained remission, although 25 (51%) required a second single-agent regimen, and 7 (14%) needed combination chemotherapy to achieve it. An average of 3.4 courses of chemotherapy were necessary to achieve remission, and 6 patients (12%) underwent resection of resistant tumor foci. Primary single-agent chemotherapy is a reasonable treatment option in patients with low-risk metastatic GTT.

Aspartate Aminotransferases↗
PubMed1991

Evolving concepts of molar pregnancy.

Molar pregnancy is composed of two distinct clinical and pathologic entities, complete and partial mole. Knowledge of the cytogenetic origin, natural history and treatment of complete and partial hydatidiform mole is evolving.

Chorionic Gonadotropin↗
PubMed1991

Gestational trophoblastic disease of the fallopian tube.

Tubal gestational trophoblastic disease (GTD) was diagnosed in 16 (0.8%) of 2,100 women with GTD managed at the New England Trophoblastic Disease Center. Tubal partial mole, complete mole and choriocarcinoma were present in 5, 5 and 6 patients, respectively. Patients with tubal GTD were not clinically distinguishable from those with traditional tubal pregnancies. While only one patient with tubal mole developed metastases, four patients with tubal choriocarcinoma presented with metastases. All the patients achieved complete, sustained remission.

Adolescent↗
PubMed1991

A clinicopathologic study of 153 cases of complete hydatidiform mole (1980-1990): histologic grade lacks prognostic significance.

Although the significance of histologic grading in hydatidiform mole has previously been investigated, most studies evaluated patients treated before 1975. Since 1975, many advances have been made in the understanding and treatment of hydatidiform mole, including the division of molar pregnancy into complete and partial hydatidiform mole. We retrospectively studied 153 cases of complete hydatidiform mole diagnosed and treated at the Brigham and Women's Hospital between 1980-1990 to determine the current prognostic significance of histologic grading in this disease. The histologic grade (based on the criteria of Hertig and Sheldon) was compared with the subsequent clinical course, including the rates of spontaneous remission, persistent gestational trophoblastic tumor, metastatic disease, "high-risk" metastatic disease, chemotherapy resistance, and survival. The histologic grade of the original complete hydatidiform mole did not correlate significantly with any index of clinical outcome evaluated.

Adult↗
PubMed1991

Duplex ultrasonography for persistent gestational trophoblastic tumor.

Duplex ultrasonography was performed on 17 consecutive patients being evaluated for persistent gestational trophoblastic tumor (GTT). All patients had had a prior molar pregnancy evacuated and presented with a rise or plateau in their beta-human chorionic gonadotropin levels. The ultrasonography was considered to be abnormal if the image demonstrated a focal area of altered echogenicity within the uterus or if Doppler scanning revealed a focal area of detectable intrauterine blood flow. The ultrasound findings were compared with the pathologic results from dilation and curettage specimens. Ten of the 17 patients had pathologically proven macroscopic tumor. Of those 10, 7 had an abnormal sonographic image (sensitivity, 70%), and 9 had an abnormal Doppler examination (sensitivity, 90%). In all 10 patients the image and/or Doppler examination was abnormal. Among four patients with microscopic disease, imaging was positive in one case, and the Doppler examination was positive in three. Imaging and Doppler ultrasonography are complementary modalities that can reliably detect persistent uterine GTT, and Doppler ultrasonography appears to be more sensitive than imaging in making this diagnosis.

Dilatation and Curettage↗
PubMed1990

Hepatic scintigraphic changes associated with gestational trophoblastic disease.

We reviewed the results of radionuclide liver imaging in 70 patients newly referred for evaluation and treatment of persistent gestational trophoblastic tumors. Some 58 patients (83%) had abnormal liver scans but no focal defects and no discernible hepatic malignancy. These diffusely abnormal scans may reflect chemotherapeutic and/or hormonal effects on the liver and should not be interpreted as indicative of metastases.

Female↗
PubMed1990

Methotrexate infusion and folinic acid in the primary therapy of nonmetastatic gestational trophoblastic tumors.

Thirty-two patients with nonmetastatic gestational trophoblastic tumors were treated with methotrexate infusion and folinic acid and the results of this therapy were compared to our prior experience with the 8-day methotrexate-folinic acid regimen. Complete remission was achieved in 22 of 32 (68.7%) patients treated with methotrexate infusion and 147 of 163 (90.2%) patients treated with the 8-day regimen (P less than 0.01). One course of chemotherapy induced complete remission in 19 (86.3%) patients treated with methotrexate infusion and 121 (82.2%) patients treated with the 8-day regimen. All 10 patients resistant to methotrexate infusion later achieved remission with other chemotherapy. Following methotrexate infusion, no patient developed myelosuppression, hepatotoxicity, or alopecia. Efforts should continue to identify new chemotherapeutic protocols that maximize remission rates and minimize toxicity and hospitalization.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Persistent gestational trophoblastic tumor after partial hydatidiform mole.

The current study investigates the clinical characteristics of patients with partial molar pregnancy who developed persistent gestational trophoblastic tumor (GTT). Between January 1979 and January 1989, 16 of 240 (6.6%) patients, who were followed for partial mole, developed persistent GTT. Fifteen (94%) patients were diagnosed as having a missed abortion before evacuation and only 1 patient presented with excessive uterine size and theca lutein ovarian cysts and was felt to have molar disease. No patient presented with toxemia, hyperemesis, or hyperthyroidism. All 16 patients developed nonmetastatic GTT. Fifteen patients achieved complete remission with methotrexate-citrovorum factor and only 1 patient required combination chemotherapy to attain remission. None of the patients had histologic evidence of choriocarcinoma. Patients with partial mole who developed persistent GTT did not have clinical or pathological characteristics that distinguished them from other patients with partial mole. All patients with partial mole should be followed with measurement of hCG levels to assure gonadotropin remission.

Adult↗
PubMed1979

New insights into the old problem of chronic pelvic pain.

Between July, 1974 and February, 1979, 109 adolescent girls, ranging in age from 10 1/2 to 19 yr. with unexplained chronic pelvic pain, underwent diagnostic laparoscopy. Endometriosis was the most common finding occurring in 49 patients (45%), followed by postoperative adhesions in 17 patients (16%) and congenital abnormalities of the uterus in 10 patients (9%). Other important causes were chronic pelvic inflammatory disease with peritubal and periovarian adhesions in 9%, chronic hemoperitoneum in 5%, functional ovarian cysts in 5%, and uterine serositis in 2%. No pathology could be seen in 10 patients (9%). Analysis of the presenting symptoms and physical findings revealed in most instances that the presence of significant pelvic pathology as a cause of the chronic pelvic pain was predictable and had been previously misdiagnosed. Intraoperative and postoperative management of the major problems encountered stress the importance of conservative surgery and the need for long-term follow-up.

Adolescent↗
PubMed1979

Methotrexate with citrovorum factor rescue for nonmetastatic gestational trophoblastic neoplasms.

Fifty-one patients with nonmetastatic gestational trophoblastic neoplasms (NMGTN) were treated with either 4 or 6 mg/kg methotrexate (MTX) and citrovorum factor (CF) rescue to determine if the higher dosage could reduce the number of courses of chemotherapy required to achieve remission. Thirty-six of 41 patients treated with 4 mg/kg MTX achieved complete remission with 1 course of chemotherapy. Increasing the initial dose of MTX to 6 mg/kg in 10 patients did not reduce the need for subsequent courses of chemotherapy but did increase associated toxicity. The rate of fall in the human chorionic gonadotropin (hCG) titer following the initial course of MTX-CF was found to be an accurate predictor of therapeutic response. The need for further chemotherapy may be anticipated if the hCG titer has not fallen by 1 log within 18 days.

Adolescent↗