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Biomedical subjects

G J Kleiner

Publications and source records attributed to G J Kleiner.

At least 19 recordsLinked to original sources
PubMed1995

Acute promyelocytic leukemia and pregnancy. A case report.

BACKGROUND: Acute promyelocytic leukemia (APL) is an uncommon form of acute myeloid leukemia usually associated with disseminated intravascular coagulation (DIC). Pregnancy in patients with APL requires special consideration to maximize the probability of survival of both mother and fetus. METHODS: A patient with APL diagnosed during pregnancy who developed DIC is described. Obstetric and oncologic management of this difficult patient is discussed, and a pertinent literature review of pregnancy in APL is presented. RESULTS: Of 23 pregnancies in patients with APL reported in the literature (including the present patient), 19 yielded live births, including 8 of 12 who received chemotherapy during late pregnancy and all 3 patients who received all-trans-retinoic acid (ATRA) during late pregnancy. Chemotherapy or ATRA induced complete remission in 72% of treated patients. CONCLUSIONS: Proper management of pregnant patients with APL usually results in a live birth and complete remission of the mother's leukemia, despite the potentially devastating consequences of DIC, which is present at diagnosis in most patients.

Adult↗
PubMed1990

Abnormal cervical cytology leading to the diagnosis of gastric cancer.

There have been nine cases reported in the English literature in which the finding of malignant cells on cervical/vaginal cytology led to the diagnosis of primary gastric cancer. We report on a patient with gastric carcinoma, metastatic to the cervix, in which the diagnosis was suspected by the finding of signet ring cells on a Papanicolaou smear of the cervix. Prior to treatment of this patient, concordance of signet ring carcinoma on cervical and ascitic fluid cytology and on cervical and gastric biopsies was documented; this has not been reported previously. Thirty-four additional cases of gastric carcinoma metastatic to the cervix are reviewed. This paper is presented to remind the clinician that, however rare, metastases from the gastrointestinal tract to the uterine cervix do occur.

Adenocarcinoma, Mucinous↗
PubMed1990

Postgraduate internship in gynecology and obstetrics for physician assistants: a 4-year experience.

Changes in the Hospital Code (405 Regulations) to limit the number of hours worked by residents have been implemented in New York state and may soon become a nation-wide policy. Although their goal is to guarantee quality of patient care and assure education for residents, the limitation of hours worked has increased manpower shortages, some of which could be resolved by using physician assistants with specialty training. To provide this training, a Postgraduate Internship in Gynecology and Obstetrics for Physician Assistants has been developed at the North Central Bronx Hospital and the Montefiore Medical Center. It is the first program of its kind at the postgraduate level to educate physician assistants specifically for practice in obstetrics and gynecology. The program consists of 3 months of didactic lectures to review and update knowledge on topics in medicine, surgery, gynecology, preoperative and postoperative care, cardiac and trauma life support, and critical care, followed by a clinical year similar to that of a rotating physician intern. We believe that such postgraduate educational opportunities in gynecology and obstetrics benefit both the individual physician assistant's growth and development and the level of care delivered, and may be an answer to staffing needs.

Curriculum↗
PubMed1987

Spontaneous clostridia gas gangrene of uterus associated with endometrial malignancy.

Only four patients with clostridia sepsis in association with gynecologic malignancy have been reported, all of whom had prior diagnostic or therapeutic intervention. Our patient is the first documented case of such clostridium sepsis that occurred spontaneously, i.e., without previous trauma, instrumentation, radiation or chemotherapy. The value of aggressive management is reviewed.

Adenocarcinoma↗
PubMed1987

Cystic papillary hidradenoma of the vulva: case report and review of the literature.

Papillary hidradenoma of the vulva is a rare, benign neoplasm arising from apocrine sweat glands of the skin. Frequently, this lesion has been mistaken for carcinoma. The treatment of choice is local excision. The prognosis for patients with this tumor is excellent. We present a patient who is unique because she had a lesion which was the largest ever recorded, and which existed over twice as long as any previously described. This case is also presented to remind the clinician that, despite the gross appearance of the tumor which resembles carcinoma on sectioning, biopsy and histological diagnosis should guide the ultimate management of patients with such lesions. The findings in our patient support the view that no matter how large or how long in existence, hidradenoma remains benign.

Adenoma, Sweat Gland↗
PubMed1985

Abdominal wall actinomycosis associated with an IUD. A case report.

Abdominal wall actinomycosis without pelvic organ involvement in users of intrauterine contraceptive devices (IUDs) has not been reported on previously. We encountered one such patient, whose uterine cervix was colonized superficially with Actinomyces. We suggest that systemic actinomycosis be included in the differential diagnosis of pain in IUD users when Actinomyces is found on Papanicolaou smears or in endocervical curettings. Such patients should be treated with appropriate antibiotic therapy, especially prior to any surgical intervention.

Abdominal Muscles↗
PubMed1982

Paraganglioma complicating pregnancy and the puerperium.

A rare case of a paraganglioma (extraadrenal pheochromocytoma) that complicated both pregnancy and the puerperium is described. The patient presented a confusing clinical picture simulating pregnancy-induced hypertension, which, after delivery, masqueraded as intractable fever of unknown origin. Computed tomography precisely identified the presence and location of the mass, which had eluded detection despite exhaustive testing. Pheochromocytoma should be considered in the differential diagnosis of postpartum fever of unknown origin, especially if associated with paroxysmal hypertension.

Adult↗
PubMed1976

Current concepts of defibrination in the pregnant woman.

The possible predisposing causes of difibrination in the pregnant woman are discussed. Coagulation profiles and qualitative and quantitative assessment of fibrinolytic activity during labor, delivery and the early puerperium in normal pregnancies are presented. These factors were also studied in patients with abruptio placentae and prolonged intrauterine fetal death and in women whose pregnancies were terminated with intraamniotic infusion of hypertonic saline or prostaglandin F2alpha. The findings suggest that a minor degree of physiologic defibrination develops during normal labor that is qualitatively similar to, but of much lesser magnitude than, the pathologic defibrination syndrome commonly associated with abruptio placentae or prolonged intrauterine fetal death. Some degree of defibrination occurs in women undergoing saline abortion, similar to that of women during normal parturition, but does not usually reach clinically significant levels. The coagulation changes seen during prostaglandin abortion suggest that a minor degree of defibrination occurs that is substantially less than that seen during saline abortion. The findings presented form a basis for the rational management of defibrination in the pregnant woman.

Abortion, Induced↗
PubMed1975

Defibrination in obstetrics. Modern concepts.

Coagulation profiles of serum fibrinogen, factors V and VIII and haemoglobin in normal pregnancies during labour, delivery and the early puerperium are presented. These factors were also studied in patients with abruptio placentae, in intra-uterine death, and in patients whose pregnancies were terminated with intra-amniotic saline and prostaglandin F2alpha. An assessment of fibrinolytic activity in these patients was made using qualitative (euglobulin lysis time) and quantitative (FR-antigen) tests. The coagulation findings presented form a basis for the rational management of defibrination in obstetrics.

Abortion, Induced↗