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Biomedical subjects

G Del Priore

Publications and source records attributed to G Del Priore.

33 records · Page 2Linked to original sources
PubMed1996

Colposcopic biopsies versus loop electrosurgical excision procedure cone histology in human immunodeficiency virus-positive women.

OBJECTIVE: To compare the discrepancy between colposcopically directed punch biopsy and excisional cone biopsy in human immunodeficiency-positive (HIV+) vs. HIV-negative (HIV-) women. STUDY DESIGN: We performed a case-control analysis of women treated with excisional cone biopsy after an abnormal colposcopic punch biopsy. Punch and cone biopsy histology were compared in 29 HIV+ (mean CD4 = 251 cells/mm3, 10 with the acquired immunodeficiency syndrome) and 31 HIV- women. Only patients with no prior treatment for cervical dysplasia, satisfactory colposcopy and cervical cytologic smears concordant with colposcopic biopsies were included. RESULTS: Disagreement between punch biopsy and cone histology was evident in 41% (12/29) of HIV+ patients and 48% (15/31) of seronegative women (chi 2, P = .78). The cone specimen had a higher grade lesion than the punch biopsy in 38% (11/29) of HIV+ patients and 32% (10/31) of seronegative women (P = .65). Overall, patients with HPV, cervical intraepithelial neoplasia (CIN) I or II on punch biopsy had CIN III on 30% of cone biopsies (5/23 HIV+ vs. 9/23 HIV-women, P = .2). In HIV+ women with HPV or CIN I on punch biopsy, 50% (9/18, 95% confidence interval 26-74%) had CIN II or III on the excisional cone vs. 18% (2/11) HIV-patients (Fisher's test, P = .13). However, in HIV+ patients with CIN II or III on cone biopsy, 47% (9/19) had only CIN I or human papillomavirus on punch biopsy as compared to 9% (2/22) HIV-patients (chi 2, P = .01). CONCLUSION: Colposcopically directed punch biopsies are poor predictors of cone histology in both HIV+ and HIV-patients. Based on confidence intervals, at least 26% and as many as 74% of HIV+ women with CIN I on punch biopsy may have a significantly worse lesion on cone biopsy despite satisfactory colposcopy. Though CIN I may be observed in immunocompetent women, due to the likelihood of a more advanced lesion, observation may not be justified in HIV+ women.

Adult↗
PubMed1995

Paclitaxel-associated hypersensitivity reaction despite high-dose steroids and prolonged infusions.

The development of paclitaxel-containing chemotherapeutic regimens has been hindered by the frequent occurrence of allergic-type reactions to the drug or its diluent. Fortunately, current pretreatment regimens are associated with a reduced risk of major hypersensitivity reactions. However, there is still a group of patients that may experience these reactions from Taxol despite the use of prechemotherapy steroids and antihistamines. In a recent report, patients with prior reactions to Taxol were successfully retreated utilizing 24 hr of high-dose steroids and a very prolonged infusion regimen. We now report on two patients with major hypersensitivity reactions despite the use of this regimen. We conclude that not all Taxol-associated hypersensitivity reactions are preventable with current drug regimens. In addition, there is little evidence to support continued or exclusive use of the suggested rechallenge premedication schedule or the prolonged infusion rate.

Dexamethasone↗
PubMed1995

The value of cervical cytology in HIV-infected women.

The purpose of this study was to assess the ability of cytology to predict the results of colposcopically directed cervical biopsies in HIV-infected women. We performed a case-control study of 52 HIV(+), 31% of whom had AIDS, and 57 HIV(-) women referred to two tertiary care centers for colposcopy from July 1991 to November 1993. All 57 HIV(-) controls and 27 HIV (+) cases underwent colposcopy for evaluation of an abnormal Pap smear. The remaining HIV(+) cases (n = 25) had colposcopy as part of their routine assessment. In women with abnormal Pap smears, colposcopic biopsy agreed with the Pap smear results in 83% of 24 HIV(+) women and 65% of 37 controls (chi 2; P = 0.34). For patients with low-grade SIL on Pap smear, 14% of HIV(+) and 11% of HIV(-) women had moderate or severe dysplasia on biopsy (P = 0.52). The positive predictive value of an abnormal Pap smear was 96% in HIV(+) women vs 78% in noninfected patients (P = 0.05). In the overall series of 52 HIV(+) women, the Pap smear did not match the biopsy in 44% of patients and was less severe than the cervical biopsy results in 91% of these mismatches. The Pap smear had a sensitivity of 57%, a specificity of 92%, a positive predictive value of 96%, and a negative predictive value of 39%, when compared to biopsy results in HIV-seropositive patients. Pap smears missed 43% of biopsy-proven intraepithelial lesions in this series of HIV (+) women. However, when abnormal, the Pap smear was no worse in predicting the presence and degree of an intraepithelial lesion in HIV(+) women than in noninfected women. These characteristics may justify immediate treatment of HIV(+) women at the time of colposcopy after an abnormal Pap smear given its high positive predictive value.

Adult↗
PubMed1995

Adrenal function following high-dose steroids in ovarian cancer patients.

PURPOSE: Steroid doses similar to those used to prevent paclitaxel-associated hypersensitivity reactions and cisplatin-induced nausea have been associated with hypothalamic-pituitary-adrenal (HPA) axis suppression. We assessed HPA function in patients receiving high-dose steroids as part of their chemotherapy regimen for epithelial ovarian cancer. PATIENTS AND METHODS: From January to July 1994, a cross-sectional study of HPA function was performed on patients receiving dexamethasone (DEX) as part of their paclitaxel and cisplatin chemotherapy regimen (n = 9). Patients received 20 mg of DEX orally, 6 and 12 hr prior to paclitaxel (135 mg/m2) and 10-20 mg intravenously before cisplatin (50-100 mg/m2). In addition, patients received approximately 12 mg/day of DEX orally for 4 days after their chemotherapy as an antiemetic. HPA integrity was evaluated by the administration of synthetic adrenocorticotropic hormone (ACTH). The ACTH stimulation test was performed 11-19 days after the completion of the course of DEX. Patients had fasting baseline cortisol levels drawn at approximately 0800 followed by a 25-unit intravenous injection of ACTH. Post-ACTH cortisol levels were repeated at 30 and 60 min. RESULTS: The mean (+/- SEM) fasting baseline level of cortisol was 12.4 +/- 2.3 micrograms/dl (normal, 7-23 micrograms/dl). At 30 min following ACTH administration, the mean cortisol level rose 17.1 micrograms to 29.5 +/- 1.8 micrograms/dl; at 60 min it rose 21.4 micrograms to 33.8 +/- 2.5 micrograms/dl [P < 0.001] (normal increase 9-39 micrograms). All patients demonstrated a sufficient increase in their plasma cortisol after ACTH stimulation, indicating normal HPA function on the days tested. However, there was a significant trend toward lower increases in plasma cortisol at 30 and 60 min as the interval from ACTH stimulation testing to the DEX regimen decreased (r = 0.986; P < 0.0001). The chemotherapy cycle number had no impact on cortisol response in the multivariate analysis. Based on multiple linear regression, HPA function may be suppressed for approximately 8 days, but up to 14 days from the start of this DEX regimen. CONCLUSION: Current steroid regimens prescribed with chemotherapy transiently decrease HPA function, but do not appear to inhibit the HPA axis long term. HPA function may be suppressed for approximately 8 days from the commencement of chemotherapy cycles involving DEX. Patients presenting within the first 8 days of a chemotherapy cycle using steroids with symptoms attributable to HPA suppression may benefit from HPA axis testing.

Antiemetics↗
PubMed1994

The inadequacy of standard treatment of dysplasias in a woman with acquired immune deficiency syndrome.

The current state of knowledge regarding the gynecologic care of HIV-infected women is in its infancy. Standard algorithms are not valid. We present an example of the inadequacy of routine surveillance and treatment methods in these patients. Practitioners should maintain a high index of suspicion for multifocal genital dysplasias and individualize patient follow-up and therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Effects of power and electrical current density variations in an in vitro endometrial ablation model.

OBJECTIVE: To investigate the thermal effects of electrical power and waveform on uterine tissue in vitro, using the gynecologic resectoscope with a 2.5-mm roller-bar electrode. METHODS: The power setting was increased in a serial fashion using both the modulated or damped (coagulating) and unmodulated or undamped (cutting) current to ablate endometrial uterine tissue, using a technique similar to that employed in clinical situations. The power setting ranged from 20-75 W with the modulated waveform and 40-160 W with the unmodulated waveform. Measurements of tissue damage were made by staining for hematoxylin and eosin and the respiratory enzyme dehydronicotinamide adenine dinucleotide phosphate diaphorase. RESULTS: The amount of thermal injury present correlated linearly with the amount of wattage used for either current. Regardless of the power used, the maximum amount of injury into the myometrium was 4.2 mm, representing 19% of the uterine wall thickness, well within the limits of safety. Destruction to 3 mm of myometrium was achieved significantly more often using an unmodulated waveform at greater than 90 W (chi 2, P = .03). CONCLUSIONS: Although the correlation between power and tissue damage achieved statistical significance, the relationship was weak; less than 12% of the observed variation was attributable to increasing wattage. Power and waveform alone do not appear to be clinically significant determinants of the amount of thermal injury occurring during endometrial ablation.

Burns↗
PubMed1993

Comparison of maternal serum lipids before and during parturition.

OBJECTIVE: To investigate peripartum progesterone metabolism by measuring its lipid precursors. METHODS: Serum was collected from eight pregnant women not in labor during the third trimester and again during active labor. Samples were analyzed using quantitative spectrophotometric absorbance techniques for apolipoprotein A-1, high-density lipoprotein cholesterol (HDL), and total cholesterol. RESULTS: Remote from labor, the mean gestational age antepartum was 35.6 weeks; during active labor it was 39.2 weeks. The amount of apolipoprotein A-1 present was 182.0 mg/dL before labor and 156.8 mg/dL during active labor; HDL cholesterol was 59.3 mg/dL before labor and 37.5 mg/dL during active labor, and total cholesterol was 226.6 mg/dL before labor and 144.1 mg/dL during active labor. All differences were significant at P < .05. CONCLUSION: Maternal serum lipids associated with progesterone metabolism appear to decrease in the peripartum period. Progesterone metabolism and parturition may be correlated with these lipid changes, thus identifying patients about to enter labor.

Apolipoprotein A-I↗
PubMed1991

Comparison of mononuclear cell proteins and plasma proteins before and during parturition by two dimensional electrophoresis.

Two dimensional electrophoresis is a technique whereby protein sources are organized by molecular weight and electrical charge on a polyacrylamide gel. To detect changes that may be associated with the onset of parturition, we compared electrophoresis patterns of mononuclear cell proteins and plasma proteins before and during active labor. Mononuclear cells and plasma were obtained from 5 pregnant volunteers. It appears that A-1 apolipoprotein, identified by Western Blot analysis, is increased in mononuclear cells during active labor. Conversely, a decrease in the concentration of A-1 apolipoprotein was seen in plasma during parturition. These "normal" protein patterns can now be compared with those observed in pathologic conditions including preterm labor and may allow early detection of disease by protein abnormalities before clinical signs and symptoms develop.

Blood Proteins↗
PubMedDate not supplied

A comparison of thromboembolic prophylaxis in gynecologic oncology patients.

The objective of this study was to compare two methods of thromboembolic prophylaxis: sequential compression devices alone (SCDs) vs. SCDs with subcutaneous low-dose unfractionated heparin (UH). A retrospective cohort study was conducted of 168 patients who had undergone surgery for suspected gynecological malignancies. These patients were examined for associated risk factors, method of prophylaxis, and incidence of clinically significant thromboembolic events. Of these patients, 94 (56%) received perioperative and postoperative sequential compression devices alone, while 74 (44%) received both SCDs and subcutaneous low-dose UH. The postoperative course of these patients, while in the hospital and after discharge, was followed for clinically evident thromboembolic complications. Univariate and multivariate analyses were performed. The two groups were comparable in terms of most risk factors, including age, stage, height, weight, body surface area, estimated blood loss, total anesthesia time, and nodal disease. Six of 94 patients (6.4%) in the SCDs group suffered from venous thromboembolism, while four of 74 patients (5.4%) who received both SCDs and low-dose UH had a thromboembolic event (chi2 P = 0.79). There was no difference in postoperative changes in platelet counts between the two groups. Heparin added additional cost, 105 extra minutes of nursing time per patient per admission, and additional pain for the patient. In conclusion, the addition of subcutaneous low-dose unfractionated heparin to SCDs for prophylaxis against deep venous thrombosis in women undergoing surgery for gynecologic malignancies does not improve the outcome. Adding heparin was more expensive, time consuming, and painful. Heparin should not be used with SCDs unless an additional benefit can be demonstrated in a randomized controlled trial.

Anticoagulants↗
PubMedDate not supplied

Urinary incontinence in gynecological oncology patients.

The objective of this study was to investigate the prevalence and significance of urinary incontinence (UI) symptoms in gynecological oncology (GO) patients and to test the gynecologists' proficiency in eliciting these symptoms. A prospective survey using questionnaires was designed. Two faculty practice offices in the United States were chosen for the study. Forty GO patients and 40 general gynecology patients were selected from the most recent outpatient appointments of the two hospitals. We used the Urogenital Distress Inventory and the Incontinence Impact Questionnaire to elicit UI symptoms in GO patients and compared the results with their medical records. A control group, selected from a general gynecological practice, was included for comparison. The main outcome measures were to investigate the prevalence and detection rates of UI in GO patients. GO patients were significantly more likely to report UI symptoms on the questionnaire than their gynecologist was able to elicit during a consultation (P < 0.001). The survey found that 60% (24/40) of the GO patients reported at least one symptom of UI, with 23% complaining of "severe" symptoms. Of those patients who reported the symptoms on questionnaire, only 5% (2/40) were detected at the initial physician assessment (P < 0.01). Eighteen percent of the GO patients reported that the UI symptoms adversely affected their quality of life. The prevalence of symptoms was not associated with the primary cancer site. There was no difference in detection rates between the two practice settings. In a multivariate analysis, there was no factor that emerged as the best discriminator for a positive response to the questionnaire. A significant proportion of GO patients report severe UI symptoms that are not detected by gynecologic oncologists or gynecologists during routine consultations.

Adult↗
PubMedDate not supplied

Selective vessel ligation in the pelvis: an invaluable tool in certain surgical procedures.

While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. The question of how many vessels the uterus requires to ensure its viability arose. Following an abdominal radical trachelectomy for stage IB cervical carcinoma, blood supply of the body of the uterus is successfully maintained by only the two infundibulopelvic vessels (n= 34). Pregnancy has resulted following this technique (n= 2). Selective ligation of the pelvic vasculature has been utilized in the abdominal radical trachelectomy procedure. The objectives of this study were to investigate the vasculature of the infundibulopelvic and broad ligaments, to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion, and to consider the clinical applications of selective pelvic vessel ligation. Ten fresh dissections of the infundibulopelvic vessels, broad ligaments of benign total abdominal hysterectomy, and bilateral salpingo-oophorectomy specimens were performed. Perfusion index (PI) and oxygen saturation (O(2)Sat) measurements using a modified probe were taken at specified intervals at the uterine cornu during ten routine benign abdominal hysterectomies to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion and the concepts studied were utilized in certain gynecological procedures. The ovarian/infundibulopelvic vessels course medially through the broad ligament toward the uterine cornu and consistently give off a branch to the ovary on its lateral border. In addition, further vessels were noted to run laterally from the uterine cornu along the ovarian ligament to the medial aspect of the ovary. PI and O(2)Sat measurements imply that the uterine and ovarian vessels contribute almost equally to uterine perfusion. Clinical application by selective ligation of the pelvic vasculature has been utilized in certain gynecological procedures often prone to torrential life-threatening uterine hemorrhage. Selective temporary ligation of the uterine and ovarian vessels has proven useful in the surgical management of chemoresistant gestational trophoblastic disease, in the Strassman procedure, fertility-sparing surgery in ruptured cornual ectopic pregnancies, and unrelenting postpartum hemorrhage. Of the six supplying vessels (ovarian, uterine, and vaginal) to the uterus only two (ovarian or uterine or a combination thereof) are required for uterine viability.

Female↗
PubMedDate not supplied

Preliminary phase II clinical and pharmacokinetic study of 9-cis retinoic acid in advanced cervical cancer. New York Gynecologic Oncology Group.

PURPOSE: 9-cis retinoic acid (ALRT 1057; 9cRA) is a promising new retinoid that binds to all known retinoic acid receptors (RAR and RXR), potentially providing it with a broader spectrum of biologic activity than either 13-cis retinoic acid or all-trans retinoic acid. It has been shown to be at least as active as all-trans retinoic acid as a differentiation-inducing and antiproliferative agent in both in vivo and in vitro tumor model systems. METHODS: The New York Gynecologic Oncology Group undertook a prospective, multi-institutional phase II clinical and pharmacokinetic trial of 9cRA in patients with advanced or recurrent squamous cell or adenosquamous cell carcinoma of the uterine cervix. Patients received daily oral doses of 140 mg/m2 of 9cRA. 9cRA and its metabolites were determined by reversed-phase HPLC in plasma samples drawn at 0.5 to 8 hours. RESULTS: Sixteen patients with advanced or recurrent carcinoma of the cervix were enrolled. Therapy was well tolerated with no unexpected toxicities. There were no complete or partial responses observed, indicating that a response rate of 20% or greater to this agent could be ruled out with 95% confidence. Pharmacokinetic parameters for 9cRA on day 1 were in agreement with previous studies. The area under the plasma versus time curves for 9cRA declined by 69% between days 1 and 8 with daily 9cRA dosing and remained at this low level in those patients evaluated on day 28. 4-oxo-9-cis retinoic acid (4-oxo-9cRA) was identified as a major plasma metabolite of 9cRA. Plasma levels of 4-oxo-9-cRA were initially 71% of those of 9cRA, but in contrast to 9cRA, there was no decline in plasma levels on days 8 and 28. The ratio of the area under the curve for the 4-oxo metabolite relative to that of the parent compound increased from less than 1 on day 1 to approximately 2.4 on days 8 and 28. Thus, despite early induction of its own metabolism, levels of total retinoid metabolites persisted at pharmacologic levels at day 28. CONCLUSIONS: 9cRA with this dose and schedule was inactive in women with advanced carcinoma of the cervix. Despite a decline in plasma levels of 9cRA over time, levels of the 4-oxo metabolite tended to persist. While the 4-oxo metabolite is less potent than the parent compound, these data nevertheless suggest that the lack of clinical activity in this patient population may not be attributable exclusively to suboptimal pharmacokinetic parameters.

Adult↗