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Biomedical subjects

J Bornstein

Publications and source records attributed to J Bornstein.

At least 37 records · Page 2Linked to original sources
PubMed1997

Vestibulodynia--a subset of vulvar vestibulitis or a novel syndrome?

OBJECTIVE: Our purpose was to recognize special features of women with both vestibulitis and constant vulvar pain (vestibulodynia) and to determine whether vestibulodynia is a separate disease entity or a subset of vestibulitis. STUDY DESIGN: Ninety-one women with severe vulvar vestibulitis underwent perineoplasty by a single surgeon during 1992 to 1995. Twenty-five (27%) of them who had vestibulodynia were compared with 66 (73%) who had dyspareunia alone. With univariate and then multivariate analysis, the two groups were compared with regard to demographic, social, and medical variables, the presence of human papillomavirus deoxyribonucleic acid, physical findings in the vestibule, and surgical outcome. RESULTS: The vestibulodynia and vestibulitis groups differed in age (30.5 +/- 10.6 years vs 24.7 +/- 6.2 years respectively), as well as in marital status (married, 44% vs 18%, respectively), nonuse of contraception (20% vs 1%, respectively), presence of human papillomavirus deoxyribonucleic acid in the vestibule (80% vs 48%, respectively), and failure of surgical treatment (incomplete response rate, 64% vs 2%, respectively). With multivariate analysis, patients with human papillomavirus deoxyribonucleic acid present in the vestibule have an odds ratio of 5.44 (95% confidence interval, 1.45 to 20.33) of belonging to the group with vestibulodynia, whereas dysuria and age have odds ratios of 3.70 (95% confidence interval 1.09 to 12.55) and 1.14 (95% confidence interval 1.04 to 1.24), respectively. CONCLUSIONS: Vestibulodynia is a unique syndrome in that it affects women who are older than those who have vestibulitis alone and it is associated with human papillomavirus deoxyribonucleic acid, dysuria, and a higher surgical failure rate than that for vestibulitis.

Adolescent↗
PubMed1997

Predicting the outcome of surgical treatment of vulvar vestibulitis.

OBJECTIVE: To identify predictive factors for success or failure of perineoplasty for severe vulvar vestibulitis. METHODS: Seventy-nine women with severe vulvar vestibulitis underwent perineoplasty by a single surgeon during 1992-1994. Sixty (76%) who experienced a complete response were compared with 19 (24%) who had an incomplete response. Using univariate and then multivariate (logistic regression) analysis, the two groups were compared with regard to preoperative demographic, social, and medical variables, as well as physical findings in the vestibule. RESULTS: The complete- and incomplete-response groups were similar in all comparisons except for constant vulvar pain of vestibular origin (in addition to dyspareunia) and the presence of symptoms since first coitus. On multiple logistic regression, these characteristics had odds ratios (and 95% confidence intervals) of 4.97 (1.49, 16.63) and 5.83 (1.74, 19.55), respectively. CONCLUSION: An incomplete response to perineoplasty may be anticipated in women with vulvar vestibulitis associated with dyspareunia since their first episode of intercourse and in those with associated persistent vulvar pain. Treatment approaches other than surgery should be considered for such patients.

Adolescent↗
PubMed1997

Combination of subtotal perineoplasty and interferon for the treatment of vulvar vestibulitis.

PURPOSE: To evaluate the efficacy of a combination of subtotal perineoplasty and interferon (IFN) infiltration of the remaining anterior vestibule in the treatment of vulvar vestibulitis. BASIC PROCEDURES: Nineteen women with vulvar vestibulitis were randomized to undergo either a total perineoplasty or a subtotal perineoplasty without removal of the anterior vestibule. The second group was further treated 6 weeks later with injection of the anterior vestibule by IFN. Differences in outcome between the groups were analyzed using Fisher's exact test. MAIN FINDINGS: The combination of subtotal perineoplasty and IFN injections was successful in 7 of 10 women, similar to the outcome of the group undergoing total perineoplasty (6 of 9 patients). CONCLUSION: A combination of subtotal perineoplasty and IFN injections to the anterior vestibule is as effective as total perineoplasty and has less surgical complications.

Adolescent↗
PubMed1997

Recombinant human interferon-beta for condylomata acuminata: a randomized, double-blind, placebo-controlled study of intralesional therapy.

To assess the efficacy of a novel glycosylated mammalian cell derived recombinant human interferon-beta (r-hIFN-beta-1a) in the intralesional treatment of genital condylomata acuminata. The study was randomized, double-blind and placebo-controlled. Patients (n=60) with up to 8 distinct condylomata acuminata were randomized to receive either one million international units (IU) of r-hIFN-beta-1a or placebo intralesionally into each lesion, 3 times a week, for a total of 9 occasions. Biopsies were taken from each patient before enrolment to allow human papillomavirus (HPV) testing, and patients were tested for the development of anti-IFN-beta antibodies. Efficacy was assessed by measuring the complete response rate 3 months after treatment. The complete response rate was not significantly better with r-hIFN-beta-1a than with placebo. However, after 3 months, 73.3% of patients treated with r-hIFN-beta-1a had experienced at least a partial response to treatment, compared with 33.3% of placebo-treated patients. At 19 days and 6 weeks, r-hIFN-beta-1a produced a significantly larger reduction in the area of condylomata. Lesions with detectable HPV6 or 11 showed a trend towards a better response rate to treatment with r-hIFN-beta-1a than lesions where no HPV DNA was detected. The treatment was well tolerated. In the 5 patients who developed non-neutralizing anti-IFN-beta antibodies, therapeutic efficacy was not compromised. Intralesional r-hIFN-beta-1a was effective in the reduction of the size of genital condylomata acuminata.

Adolescent↗
PubMed1997

Severe vulvar vestibulitis. Relation to HPV infection.

OBJECTIVE: To determine whether patients with human papillomavirus (HPV)-associated vestibulitis present differently from patients with HPV-negative disease and whether the presence of HPV is a predictor of the outcome of surgical treatment by perineoplasty. STUDY DESIGN: Thirty-eight women with severe vulvar vestibulitis who underwent surgical perineoplasty were found to have HPV DNA in the vestibule by polymerase chain reaction. Thirty-six other women with severe vestibulitis had no HPV DNA in the surgical specimen. The two groups were compared with regard to demographic, social and medical variables as well as physical findings in the vestibule and response to operative treatment. RESULTS: Both groups were found to be similar in respect to age (mean 25.9 +/- 7.93 versus 25.47 +/- 5.8, respectively), parity, education, smoking habits, contraceptive use, presence of primary vestibulitis, presence of dysuria and involvement of the whole vestibule (both anterior and posterior). More unmarried than married women were infected with HPV (P < .002). There was no significant correlation between the presence of HPV and the outcome of surgical treatment (P < .6, relative risk = 0.9, 95% confidence interval = 0.5-1.5). CONCLUSION: Although HPV DNA was found in more than half of women with vestibulitis, it appears to play no role in the presentation or response to surgical therapy for vulvar vestibulitis.

Adolescent↗
PubMed1996

Follow-up of small, postmenopausal ovarian cysts using vaginal ultrasound and CA-125 antigen.

To determine the natural history of small, simple ovarian cysts in postmenopausal women, 51 postmenopausal patients with small (< 5 cm), smooth, aseptate, hypoechogenic ovarian cysts, without ascites, were followed by vaginal ultrasound examinations every 3 months for an average period of 2.5 years. In 34, CA-125 antigen was measured and found to be within normal limits. None of the cysts showed changes in texture, nor did ascites appear. The CA-125 antigen serum levels remained low. The mean size of the cysts decreased with time. There was no statistically significant correlation between the initial size of the cyst, its tendency to grow or shrink, and the absolute CA-125 serum level. Our findings support the option of a conservative follow-up by repeated ultrasonic and CA-125 antigen examinations of small, simple cysts in postmenopausal women.

Adult↗
PubMed1996

Polymerase chain reaction search for viral etiology of vulvar vestibulitis syndrome.

OBJECTIVE: Our purpose was to assess the prevalence of infections by human papillomavirus, herpes simplex virus, and cytomegalovirus among women with severe vulvar vestibulitis. STUDY DESIGN: Eighty-six women referred for dyspareunia and diagnosed as having severe vestibulitis underwent perineoplasty, including surgical removal of the sensitive vestibule. Controls included 25 age-matched patients without dyspareunia undergoing vaginal operations for various benign causes or undergoing repair of an episiotomy. Polymerase chain reaction analysis was carried out to determine the presence of viral genes. RESULTS: The prevalence of herpes simplex virus and cytomegalovirus among the subjects tested was nil, whereas human papillomavirus was detected in 46 cases (54%). The human papillomavirus present was not of types 6, 11, 16, 18, or 33. Only one woman of the 25 asymptomatic controls (4%) had human papillomavirus deoxyribonucleic acid in the vestibule (p < 0.001). CONCLUSION: Our data provide support for the idea that vulvar vestibulitis is associated with human papillomavirus deoxyribonucleic acid in more than half of cases.

Adolescent↗
PubMed1995

Etiology of cervical cancer: current concepts.

The data on the etiological factors presented here may enable us to suggest a synergism between the various factors associated with the pathogenesis of cervical cancer. Infection of the cervix by HPV 16/18 may result in persistence of viral DNA. The persistent HPV-DNA undergoes disruption at the E2 region, when integrated into the host genome. The transcriptional products E6 and E7 oncoproteins bind to and cause the degradation of p53 and Rb tumor-suppressor gene products. It is possible that, at that point, other cofactors may be involved in the progression toward a precancerous or cancerous condition. Those cofactors may include cigarette smoking, by introducing co-carcinogens to the tissue or by suppressing the local or systemic immune resistance similar to the effect of depressed immune resistance seen in AIDS or immunosuppression of transplant patients; hormones, by enhancing growth of HPV and transformation of HPV infected cells; low serum vitamin levels leading to decreased tissue resistance; or other infections causing local inflammation and the production of free radicals. CIN develops, leading eventually to cervical cancer.

Contraception↗
PubMed1995

Perineoplasty compared with vestibuloplasty for severe vulvar vestibulitis.

OBJECTIVE: To evaluate the efficacy of vestibuloplasty (vestibular undercutting without excision) to treat severe vulvar vestibulitis. DESIGN: Prospective randomisation of patients scheduled for surgery to undergo either perineoplasty or vestibuloplasty. Differences in outcome between groups were analysed using Fisher's exact test. SETTING: The Vulvar Clinic and referral centre for vestibulitis, Kupath Holim Health System, Department of Obstetrics and Gynaecology, Carmel Medical Centre, Rapapport Faculty of Medicine, Hatechnion, Haifa, Israel. SUBJECTS: Twenty-one women with vulvar vestibulitis. RESULTS: Vestibuloplasty failed to relieve symptoms in 10 women, while perineoplasty resulted in complete resolution of symptoms in 9/11 women (P < 0.002). CONCLUSIONS: The poor outcome of vestibuloplasty, if also reported by other centres, may render it an unacceptable treatment for vulvar vestibulitis. Vestibuloplasty aims to denervate sensitive vestibular tissue, and its failure may suggest that innervation disturbances are not the main cause of the syndrome.

Adolescent↗
PubMed1995

Choriocarcinoma of the bladder. Report of a case of primary tumor or late metastasis of a molar pregnancy.

Choriocarcinoma of the bladder was diagnosed in a 54-year-old woman presenting with macroscopic hematuria 17 years following evacuation of a molar pregnancy. The patient was treated by cystoscopic transurethral tumor resection followed by three courses of triple-agent chemotherapy and total abdominal hysterectomy with bilateral salpingo-oophorectomy. Six months later a gradual rise in beta-human chorionic gonadotropin levels led to the diagnosis of recurrent bladder tumor at the site of the previous tumor. The patient underwent a conservative partial cystectomy, and 12 months postoperatively there was no evidence of disease. It is unclear whether the patient developed a primary urinary bladder choriocarcinoma or late metastatic disease from the previous molar pregnancy.

Choriocarcinoma↗
PubMed1995

Double-balloon instillation device for second-trimester abortion. Outcome in 340 consecutive cases.

For the past five years we have used a double-balloon device for extraovular instillation of prostaglandin solution for termination of midtrimester pregnancy. In 340 consecutive cases a success rate of 91% (abortions within 24 hours) was achieved, with a mean instillation-to-abortion interval of 17.5 +/- 6.5 (SD) hours in nulliparas versus 12.8 +/- 6.1 in multiparas (P < .005). The instillation of continuous, low-dose prostaglandin solution into the extraovular space resulted in very few side effects and no complications. Furthermore, the technique was used successfully in women who had undergone one or more cesarean sections in the past. The use of prostaglandin E2 (PGE2) resulted in shorter instillation-to-abortion intervals than did prostaglandin F2 alpha (P < .01); 500 micrograms/h of PGE2 solution was needed in nulliparas, whereas 250 sufficed in multiparas.

Abortion, Induced↗
PubMed1994

Diagnostic pitfalls of ultrasonographic uterine screening in women treated with tamoxifen.

Recent reports of an association between tamoxifen treatment for breast cancer and endometrial pathology prompted a screening program for women receiving tamoxifen. Twenty-two women were examined; 15 were asymptomatic, and 7 were referred because of abnormal vaginal bleeding. All underwent vaginal ultrasonography followed by endometrial sampling. The sonographic studies showed endometrial abnormalities in all 22 women--typically, irregular thickening of the endometrium. Some had cystic formations, and three had fluid in the endometrial cavity. No pathology or inadequate material was found in the endometrial samples from the 15 asymptomatic women. Endometrial polyps were suspected sonographically and removed from two of the five women with vaginal bleeding. The discrepancy between the sonographic findings and histology in the asymptomatic women could have been due to stromal edema from tamoxifen treatment. Abnormal ultrasonographic findings in asymptomatic women treated with tamoxifen probably represent insignificant changes in the endometrial architecture and not a true abnormality. The need for routine endometrial sampling or hysteroscopy in every case is therefore questionable.

Aged↗
PubMed1993

Vaginal ultrasonography in patients with postmenopausal bleeding.

Our objective was to define a subset of women with postmenopausal bleeding in whom the accepted practice of endometrial sampling could be safely omitted. Vaginal endosonographic measurements were compared to the histological findings of curettings following diagnostic dilatation and curettage in 129 women with post-menopausal bleeding who were not receiving hormonal therapy. Atrophy was diagnosed in 49%, slight proliferation in 10%, endometrial polyps in 11%, hypoplasia in 12%, and adenocarcinoma in 12%. Endometrial atrophy was associated with a mean sonographic thickness of 2.6 mm of the double layer (range 0-6.5 mm). Of the women with a final histological diagnosis of atrophy, 92% had an endometrial thickness of 3 mm or less. Furthermore, all women with a sonographic endometrial thickness of 3 mm or less had atrophic endometrium (p < 0.0001). An endometrial thickness of 3 mm or less would have reduced the number of dilation and curettage procedures by 45% and no cases of endometrial pathologies would have been missed. In women presenting with postmenstrual bleeding, meticulous scanning of the endometrium can select a group where endometrial sampling can be omitted from the protocol.

Journal Article↗