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Biomedical subjects

F Guidozzi

Publications and source records attributed to F Guidozzi.

At least 19 recordsLinked to original sources
PubMed2005

HIV seropositive in pregnant South African women who initially refuse routine antenatal HIV screening.

This study was instituted primarily to determine the HIV seroprevalence of pregnant South African women who refused routine HIV testing at the antenatal clinic of the Johannesburg Hospital, South Africa. Fifty such patients were identified, who, after being fully counselled and informed, agreed to participate in the study, provided total anonymity was adhered to: they did not want to know their results, irrespective of outcome. Blood specimens were given a laboratory reference number only, with no other reference to the patient and analysed utilising the ELISA immunoassay. Twenty-two of the 50 blood specimens, or 44% of patients analysed, tested positive for HIV. This is an alarming statistic, as the HIV prevalence in the general antenatal population at the Johannesburg Hospital is 29.4%.

AIDS Serodiagnosis↗
PubMed2003

Adenoid cystic carcinoma stage Ib1 treated with radical surgery displaying human papilloma virus 33 (HPV 33): immunoelectron microscopy and review.

BACKGROUND: The presence of human papilloma virus (HPV) 33 and possible myoepithelial differentiation in an adenoid cystic carcinoma of the cervix (ACC) Ib1 and the clinical outcome are reported. CASE: The case is an ACC, stage Ib1 harboring HPV 33, which was treated by radical hysterectomy and lymphadenectomy only. Human papilloma virus analysis of the tumor was done by means of nonisotopic in situ hybridization and polymerase chain reaction. Additionally immunoelectron microscopy was performed. CONCLUSION: Our patient had a vault recurrence 12 months after class III (Meigs) hysterectomy. The cancer tissue was totally excised, the lymphnodes (n = 31) were negative, and there was no lympho-vascular invasion and no perineural infiltration. The primary tumor displayed HPV 33 integration and features suggesting myoepithelial differentiation. We would recommend a low threshold for the use of radiotherapy in the management of similar findings.

Aged↗
PubMed2001

Primary mucinous adenocarcinoma of the vagina.

OBJECTIVE: Our goal was to report the management and symptoms of a patient who presented with primary mucinous adenocarcinoma of the vagina with an unusual histologic pattern. METHODS: Our methods included a retrospective description of the management, a review of the literature, and critical evaluation of the treatment modalities available for this very uncommon tumor. RESULTS: Initially posterior partial vaginectomy and abdominoperineal resection was performed with the creation of a permanent colostomy. A bilateral inguinal lymphadenopathy was performed 6 months later on the basis of a palpable enlarged lymph node. Radiotherapy was instituted thereafter. The patient remains disease-free 48 months after initial surgery and is satisfied with her quality of life. CONCLUSIONS: Primary mucinous adenocarcinoma of the vagina is a very rare tumor. Therefore individualized treatment is justified until larger series have been published.

Adenocarcinoma, Mucinous↗
PubMed2000

Management of uterine Müllerian adenosarcoma with extrauterine metastatic deposits.

OBJECTIVE: The aim of this study was to provide the management and outcome of three patients who presented with uterine Müllerian adenosarcoma associated with extrauterine metastases. METHODS: A retrospective study of three patients who were referred to our hospital was performed. One patient was referred because of vaginal metastatic deposits that were noted during investigations for primary infertility. The other two were referred because of abnormal vaginal bleeding; one of these had a large polyp protruding through her cervix into the vagina. RESULTS: In two patients the preoperative diagnosis and extent of their disease were known while in the third patient the diagnosis was only made postoperatively. All patients had a type II radical abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Two patients were given three cycles of neoadjuvant chemotherapy and pelvic irradiation over 12 weeks. Both of these patients had their diagnosis made preoperatively and the chemotherapy consisted of 240 mg/m(2) carboplatin and 80 mg/m(2) farmorubicin per cycle. The pelvic irradiation consisted of daily fractions of 1.8-Gy irradiation to a total of 45 Gy over the first 6 weeks. The other patient was given the same regime postoperatively. All patients are still alive and free of disease between 34 and 56 months. CONCLUSION: Radical surgery, chemotherapy, and irradiation provide a management option with seemingly favorable outcome for patients with uterine Müllerian adenosarcoma associated with extrauterine metastases.

Adenosarcoma↗
PubMed2000

Human immunodeficiency virus infection and invasive cervical cancer in South Africa.

PURPOSE: The goal of this study was to determine whether South African HIV-seropositive women with invasive cervical cancer present with disease that is more advanced than that of HIV-seronegative women and whether degree of immunosuppression affects the extent of disease at initial presentation. METHODS: This study is a retrospective review of 60 HIV-seropositive and 776 HIV-seronegative new cases of invasive cervical carcinoma seen at the combined gynecologic oncology unit of the University of the Witwatersrand, Johannesburg, South Africa. RESULTS: The HIV seroprevalence was 7.2%. Squamous cell carcinoma was the histologic subtype in more than 90% of both cohorts of patients. Although the HIV-positive patients presented with invasive cervical cancer almost 10 years earlier than the HIV-negative patients, i.e., mean age 44 years +/- 9.8 versus 53 years +/- 12.7, respectively (P </= 0.001), there was no difference in the distribution of advanced lesions in the two groups, i.e., 65% in HIV-positive and 55.4% in HIV-negative patients (P = 0.177). At initial diagnosis 26 of the HIV-seropositive patients had a CD(4) cell count less than 200/mm(3), 20 (77%) of whom presented with stage III or IV cervical cancer; the remaining 34 had a CD(4) cell count above 200/mm(3), 19 (56%) of whom had advanced-stage disease. This was not significantly different (P = 0.109). However, HIV-seropositive patients with CD(4) cell counts less than 200/mm(3) had significantly more advanced-stage disease than HIV-seronegative patients, i.e., 77% versus 55.8% respectively (P = 0.041). CONCLUSION: HIV-seropositive patients presented with invasive cervical cancer almost 10 years earlier than HIV-seronegative patients. Even though HIV seropositivity on its own did not appear to adversely affect extent of disease at presentation, patients with CD(4) cell counts below 200/mm(3) are significantly more likely to have advanced-stage disease at initial diagnosis than HIV-negative patients.

Adult↗
PubMed2000

Maternal mortality in a tertiary center after introduction of free antenatal care.

OBJECTIVE: Determination of maternal mortality rate (MMR) and the main causes of maternal death after the implementation of free antenatal care in a tertiary center in South Africa. METHODS: Retrospective case study on maternal deaths from 1 January 1993 to 31 July 1997. RESULTS: The maternal mortality rate was 128/100000 births. Hypertension disorders (18%), hemorrhage (18%) and sepsis (13%) were the most important causes of death; 44% of all deaths were considered preventable. CONCLUSIONS: The high percentage (44%) of preventable deaths is a cause of concern and is the result of increased workload, decreased staff numbers and late referrals with low socio-economic class of the patient. The discrepancy in the mortality rate between patients booked at the tertiary institution (29.8/100000) and patients booked elsewhere (304.7/100000) or not booked at all (348.5/100000) indicates the need for improving antenatal care in the periphery.

Adult↗
PubMed2000

Announcing the winner of the IJGO prize paper award for 1999. Estrogen replacement therapy in breast cancer survivors

Objective: To determine whether estrogen replacement therapy (ERT) adversely affected outcome of breast cancer survivors. Method: A prospective descriptive study of all breast cancer survivors who requested ERT because of intractable menopausal symptoms. All patients presented voluntarily as gynecological outpatients and were all given oral continuous opposed ERT: 20 premarin and medroxyprogesterone and four tibolone. Results: Twenty-four patients who had previously been treated for breast cancer 8-91 months prior to their initiating ERT have been observed for 24-44 months. There were 15 patients with stage 1, eight with stage 2 and one with stage 4 breast cancer. The mean age of the patients at commencement of ERT was 48 years (range 42-161). Two patients had a biopsy of a suspicious breast nodule: both of which were benign. There have not been any recurrences to date. Conclusion: Breast cancer survivors did not have their outcome adversely affected by ERT during an observation period of 24-44 months.

Journal Article↗
PubMed1999

Estrogen replacement therapy for ovarian carcinoma survivors: A randomized controlled trial.

BACKGROUND: Surgery for premenopausal and perimenopausal patients with epithelial ovarian carcinoma may often result in significant menopausal symptoms. Physicians may well be reluctant to prescribe, and patients loathe to take, postoperative estrogen replacement therapy because they fear that supplementation may lead to ovarian carcinoma relapse. This randomized prospective study was undertaken to determine whether postoperative estrogen replacement therapy had a negative influence on the disease free interval and overall survival of ovarian carcinoma survivors. METHODS: Between January 1987 and June 1994, at the time of a routine consultation held 6-8 weeks postoperatively, 130 patients younger than 59 years with invasive epithelial ovarian carcinoma were randomized to continuous oral conjugated equine estrogen (ERT) or to no supplementation (non-ERT). All patients were followed prospectively for a minimum of 48 months. RESULTS: Three patients in the ERT group and 2 in the non-ERT group were lost to follow-up, so 59 and 66 were finally analyzed in their respective groups. Nine patients originally randomized to ERT refused or stopped their supplementation, whereas 5 in the non-ERT commenced taking estrogens. A total of 32 recurrences occurred in the ERT group and 41 in the non-ERT group. The median disease free interval was 34 versus 27 months, respectively, whereas overall survival was 44 versus 34 months, respectively, for the two groups. The differences in disease free interval (P = 0.785) and overall survival (P = 0.354) between the two groups were not statistically significant. CONCLUSIONS: Postoperative estrogen replacement therapy did not have a negative influence on the disease free interval and overall survival of ovarian carcinoma survivors.

Adult↗
PubMed1999

Management of diabetic pregnant patients in a tertiary center in the developing world.

OBJECTIVES: To audit our insulin regimen in our antenatal diabetics. METHODS: 170 pregnant diabetic patients were retrospectively analyzed. RESULTS: The perinatal mortality rate was 37/1000, vs. a perinatal mortality rate of 30/1000 in our setting. Cesarean section rate was 49%. Strict blood-glucose control reduced the incidence of macrosomia and polyhydramnios. Routine amniocentesis for fetal-lung maturity was not practiced. CONCLUSION: Satisfactory results in pregnant diabetic patients are achievable with an established insulin regimen in a developing country.

Adult↗
PubMed1999

Estrogen replacement therapy in breast cancer survivors.

OBJECTIVE: To determine whether estrogen replacement therapy (ERT) adversely affected outcome of breast cancer survivors. METHOD: A prospective descriptive study of all breast cancer survivors who requested ERT because of intractable menopausal symptoms. All patients presented voluntarily as gynecological outpatients and were all given oral continuous opposed ERT: 20 premarin and medroxyprogesterone and four tibolone. RESULTS: Twenty-four patients who had previously been treated for breast cancer 8-91 months prior to their initiating ERT have been observed for 24-44 months. There were 15 patients with stage 1, eight with stage 2 and one with stage 4 breast cancer. The mean age of the patients at commencement of ERT was 48 years (range 42-61). Two patients had a biopsy of a suspicious breast nodule: both of which were benign. There have not been any recurrences to date. CONCLUSION: Breast cancer survivors did not have their outcome adversely affected by ERT during an observation period of 24-44 months.

Adult↗
PubMed1996

Image analysis of cellular DNA content in peritoneal fluid of patients with ovarian tumors of low malignant potential and invasive epithelial ovarian cancer.

Image analysis has rarely been used to quantitate the DNA content of intact cells derived from peritoneal fluid in patients with ovarian malignancy. An average of 118 (range 100-208) of the most atypical, visually selected Feulgen-stained cells in peritoneal fluid obtained from 46 patients undergoing primary cytoreductive surgery for histologically proven ovarian tumors of low malignant potential and truly invasive ovarian cancer were evaluated retrospectively using the SAMBA-4000 Image analysis system. The patients were stratified into 3 groups: 16 with ovarian tumors of low malignant potential (LMP), 14 with low-stage disease (LSD) (FIGO I and II), and 16 with advanced-stage (ASD) (FIGO III and IV). A pattern of high-degree aneuploidy with negative balance (means: LMP, 3.3; LSD, 20.5; ASD, 32.0), increased proliferative index (LMP, 11.2; LSD, 16.1; ASD, 13.9), and percentage of cells with DNA content greater than 5C (LMP, 6.7; LSD, 6.5; ASD, 9.5) was demonstrated in the peritoneal fluid of 8 of 16 patients with LMP (50%), 8 of 14 patients with LSD (57%), and 13 of 16 with ASD (81%). The median disease-free interval for patients with invasive epithelial ovarian cancer with peritoneal DNA diploid tumor cells was 57 months and for those with DNA aneuploid tumor cells 28 months, while in patients with LMP it was 65 and 54 months, respectively. In total, 19 patients developed a recurrence (LMP, 2; LSD, 5; ASD, 12) of which 17 were shown to have DNA aneuploid cells in the peritoneal fluid. Multivariate analysis, however, did not identify aneuploid population in the fluid, ploidy balance, proliferation indices, or degree of hyperploidy as an independently significant variable for predicting recurrence. It did appear, however, that tumor cells in peritoneal fluid with a degree of hyperploidy greater than 8 had a strong correlation for development of recurrence, although not statistically significant. Interactive image analysis of tumor cells in peritoneal fluid proved to be a valuable adjunct to cytodiagnosis. Seven of 28 patients (25%) who were underdiagnosed by cytology alone (LMP, 2; LSD, 3; ASD, 2) were shown to have malignant cells in their peritoneal fluid, while 2 of 18 patients (11%) who were called positive by cytology (LMP, 1; LSD, 1) showed diploid pattern histograms and upon review were interpreted as reactive mesothelial cells.

Adult↗
PubMed1996

Screening for cervical cancer.

It is well accepted that conscientious and widespread use of cervical cytology will significantly decrease the incidence and mortality rates of cervical cancer. The Papanicolaou smear for cervical cytology fulfills all the criteria for an ideal screening test. Not only is it cost effective, acceptable to most patients, and adaptable to widespread screening, it is sensitive enough to detect preinvasive disease resulting in decreased morbidity and mortality. Nevertheless, in developing countries cervical cancer still occurs at epidemic proportions, where an estimated 460,000 new cases per annum will be diagnosed, a significant proportion of which will be in advanced stages. First world notions pertaining to screening have proved unrealistic for the developing health care system of third world nations. This article provides an overview of screening for cervical cancer and considers cytological smearing, cervicography and direct visualization of the cervix, be it without or with the application of 4 percent acetic acid.

Developing Countries↗
PubMed1996

Management of snake and spider bite in pregnancy.

The fact that venomous snakebites during pregnancy result in a high fetal wastage and that both venomous snake and spider bites may cause maternal mortality, makes this an important, albeit uncommonly encountered, entity in obstetrics. Perhaps the most difficult aspect of dealing with this clinical situation is that care must be rendered simultaneously to two patients with a complex interrelationship. The object is to optimize maternal care and increase the chances of successful pregnancy. Adherence to the tenet that what is best for the mother is best for the fetus will probably produce the most satisfactory outcome.

Antivenins↗
PubMed1996

Screening for ovarian cancer.

Ovarian cancer is the leading cause of death from gynecologic cancer. Despite aggressive cytoreductive surgery and platinum-based chemotherapy, the 5-year survival for patients with clinically advanced ovarian cancer is only 15 to 20 percent, although the cure rate for stage I disease is usually greater than 90 percent. These statistics provide the primary rationale for ovarian cancer screening. This overview of the current literature serves to show that mass screening for ovarian cancer is far from being established and fraught with management and procedural dilemmas. The reasonable assumption being that there is little evidence to support widespread screening of large populations of women who do not have familial or genetic risk factors for ovarian cancer.

Cause of Death↗
PubMed1995

A prospective study of iron status in white and black pregnant women in an urban hospital.

Evaluation of the iron status (haemoglobin and ferritin concentrations, and percentage transferrin saturation) in a prospective study of 65 pregnant women (55 white and 10 black) revealed that adequate maternal iron stores during pregnancy cannot be maintained with prevailing dietary patterns. Although 80.6% of the patients had normal indices in the first trimester, only 12.3% were normal in the third. Significant depletion of iron stores occurred in the second trimester, but significant iron-deficient erythropoiesis only occurred in the third trimester. Despite the decline in iron status, iron deficiency anaemia was only seen in 7-8% of the patients. Even after correction for the haemodilution and increased transferrin concentrations in pregnancy, over 70% of women had depleted iron stores in the third trimester. No beneficial effect on fetal birth weights was found on withholding of maternal iron supplementation. This study clearly demonstrated that white and urban black pregnant women require iron prophylaxis to maintain iron stores.

Adult↗
PubMed1994

Characterization of peripheral blood and ovarian cancer-infiltrating lymphocytes: effect of HIV infection on phenotypic expression and proliferative response.

A study that focused on the identification of the phenotype and proliferative responses of peripheral blood and ovarian cancer-infiltrating lymphocytes in a patient with stage III ovarian cancer who had human immunodeficiency virus infection is presented. Monoclonal antibodies and flow cytometry were used to determine the phenotypic expression, while thymidine incorporation response to stimulation by phytohemagglutinin and concanavalin A was used to determine the proliferative response. These immunologic characteristics were compared with the results of similar analyses performed in four HIV-seronegative patients with stage III ovarian cancer. The CD4:CD8 ratio in peripheral blood and ovarian tumor in the HIV-seropositive patient was 0.43:1 and 0.46:1, respectively, while in the four seronegative patients it was 1.83:1 and 0.64:1, respectively. The absolute and mean CD4 counts in the peripheral blood in the HIV-seropositive patient and HIV-seronegative patients was 260/mm3 and 707/mm3 (611-743), respectively, while in the ovarian tumor the percentage distribution of CD4 was 13 and 21% (9-44%), respectively. Despite there being intratumor immunosuppression in all five cases, the proliferative response was most markedly suppressed in the HIV-seropositive patient. Although surgery and chemotherapy were well tolerated, the HIV-seropositive patient died 6 months later with rapidly progressive disease. The remaining four HIV-seronegative patients are all alive, between 9 and 14 months postoperatively.

Aged↗
PubMed1994

Extensive primary cytoreductive surgery for advanced epithelial ovarian cancer.

This retrospective descriptive study provides our experience with a subset of 30 patients with Stage III or Stage IV ovarian cancer who presented at initial laparotomy with advanced disease in whom large (greater than 10 cm) confluent nodules, plaques, or nodal metastatic deposits were found intraperitoneally. The nature of the extirpative procedures performed resulted in extensive primary cytoreductive surgery involving multiple organ resection. All the patients had removal of their primary tumor from the pelvis, an omentectomy, and appendectomy. In addition to resection of rectosigmoid colon in 27 patients, 11 had concomitant resection of the small bowel and 13 of the large bowel, 3 of which were hemicolectomy. In the remaining 3 patients who did not have rectosigmoid resection a hemicolectomy was performed, 2 of which also had resection of small bowel. Three patients required a primary colostomy, while 1 had a colostomy as a secondary procedure following the development of a rectovaginal fistula. Eight patients had a splenectomy, 2 had resection of portion of the tail of the pancreas, 10 had a partial urinary bladder cystectomy and 2 had a nephrectomy. The average operating time and blood loss was 5 hr 18 min and 2900 ml, respectively. Two patients died within 48 hr postoperatively, two required a second laparotomy for persistent intraabdominal bleeding, and six developed late thrombotic complications. In total 43% of the patients developed serious postoperative complications. We present our findings and allude to the morbidity and mortality that may ensue when such extensive cytoreductive surgery is undertaken.

Adult↗