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Biomedical subjects

M D Adelson

Publications and source records attributed to M D Adelson.

At least 37 records · Page 2Linked to original sources
PubMed1991

Structural and functional integrity of ovarian tumor tissue obtained by ultrasonic aspiration.

For patients with ovarian epithelial cancer, survival increases when residual disease approaches zero after surgical removal of the tumor. A previous study using the Cavitron Ultrasonic Surgical Aspirator (CUSA) (Cavitron Lasersonic Corp., Stamford, CT) showed the successful removal of ovarian tumors from areas often considered unresectable: the diaphragm, spleen, stomach, and small bowel. However, the CUSA has not yet been approved by the Food and Drug Administration for gynecologic surgery except on an experimental basis. This study was designed to test whether ultrasonic irradiation produced by the CUSA caused alterations in cell structure or physiology of gynecologic tissue in adjacent areas. Paired tumor samples, unirradiated and irradiated, were obtained from ten patients, and portions were sent for pathologic structural evaluation and physiologic tissue culture evaluation. Histologic sections, stained with hematoxylin and eosin, showed that CUSA irradiation produced only minor tissue distortion as observed under the light microscope. A correct diagnosis would have been made in all cases had only tissue fragments obtained from the CUSA specimen trap been stained. For nine of ten patients, initial tumor cell viability was similar in the two specimen types. Flow cytometric DNA analysis confirmed that surgical methods produced matched samples. Cells that survived high-frequency ultrasound appeared functionally intact. For five of eight patients, the cells from the CUSA specimen traps survived and/or divided to a greater extent than those from the knife-dissected tumors. Cells from both surgical routes attained a similar number of passages in culture. It seems reasonable to extrapolate these in vitro observations with pelvic tumor tissues to normal surrounding tissue left in situ. Thus pelvic tissue is believed to be uninjured by CUSA ultrasonic irradiation.

Biopsy, Needle↗
PubMed1991

Necrotizing fasciitis: a complication of squamous cell carcinoma of the vulva.

Necrotizing fasciitis is an often fatal, often initially unrecognized condition. Although it was first described over 60 years ago, occurrence in the vulva was only first recognized in 1972. The condition is most often associated with diabetes, prior injury, surgery, or irradiation. Aggressive surgical excision is required, early in the course of the disease, to salvage the patient. An association with vulvar carcinoma in a nondiabetic patient has not been previously reported. We report such a case, with a poor outcome, because surgical intervention was not possible until late in the course of the disease.

Aged↗
PubMed1991

Cytoreduction of diaphragmatic metastases using the Cavitron Ultrasonic Surgical Aspirator.

The Cavitron Ultrasonic Surgical Aspirator was used to reduce the volume of diaphragmatic metastases in 33 patients. Thirty patients had epithelial carcinoma of the ovary and one each had tubal adenocarcinoma, papillary peritoneal tumor, and mesothelioma. Twenty-seven patients had Stage IIIC disease, and six had Stage IV. Initially, 13 patients had diaphragmatic disease greater than 15 mm diameter (of any single nodule), and 2 had disease 6-15 mm diameter. After cytoreduction using standard means, 11 patients had disease greater than 15 mm diameter and 2 patients had disease from 6 to 15 mm in greatest diameter. After using the Cavitron, 1 patient had no gross diaphragmatic residual disease, and 30 patients had disease 1-5 mm diameter. No complication resulted from the cytoreduction of diaphragm disease using the Cavitron. The Cavitron Ultrasonic Surgical Aspirator is invaluable to obtain minimal residual disease of diaphragmatic metastases.

Abdominal Neoplasms↗
PubMed1991

Evaluation of two commercially available nucleic acid hybridization assays for the detection and typing of human papillomavirus in clinical specimens.

Southern blot (Oncor, Gaithersburg, MD) and dot blot (Life Technologies, Gaithersburg, MD) nucleic acid hybridization assays were compared for their ability to detect and type human papillomavirus (HPV) DNA in 50 cervical swab specimens and 11 biopsy specimens. Overall agreement between the two methods was 78.7%. With the use of Southern blot analysis, HPV 6, 11, 16, or 18 was detected in 22 specimens, however, 4 were untypable because of abnormal or smeared band patterns. Dot blot analysis detected HPV 6/11, 16/18, or 31/33/35 in those same 22 specimens and in 9 additional specimens. Eight of the 13 specimens in which HPV was not detected or untypable by Southern blot contained type 31/33/35 by dot blot. Based on convenience of specimen collection and transport, ease of performance and the ability to detect HPV types 31, 33, and 35, the authors are currently using the dot blot assay for the detection and typing of HPV in clinical specimens.

Adolescent↗
PubMed1991

A phase II trial of gallium nitrate (NSC #15200) in previously treated ovarian carcinoma. A Gynecologic Oncology Group Study.

Twenty-six evaluable patients with advanced or recurrent epithelial ovarian cancer were treated with 750 mg/m2 of gallium nitrate every three weeks. All patients had prior cisplatin chemotherapy. One patient had a complete response (3.8%), two patients had partial responses (7.7%), and six patients had stable disease (23.1%). The 95% upper confidence bound for response is 27.2%. The major toxicity was nausea and vomiting which was modest, and anemia, which was moderate to severe. Myelosuppression was minimal. Gallium nitrate has modest activity in previously treated patients with epithelial ovarian cancer.

Adult↗
PubMed1991

Lupron retards proliferation of ovarian epithelial tumor cells cultured in serum-free medium.

Some patients with recurrent ovarian epithelial cancer respond favorably to treatment with GnRH agonists. This effect was proposed to be mediated by suppression of pituitary gonadotropin release. The present in vitro study investigated effects of human gonadotropin (Pergonal LH/FSH, 1:1) and Lupron, a GnRH agonist, on proliferation of an ovarian cancer cell line, 2774, which is estrogen receptor negative and grows well in serum-free, defined medium. Pergonal, 10 IU/mL or 30 IU/mL, did not enhance cell proliferation, which argues against stabilization of ovarian tumors in vivo due to decreased serum gonadotropin. Lupron, 1.4 micrograms/mL and 140 micrograms/mL, retarded cell division by day 6-8 of culture, in a dose-dependent manner. Flow cytometric cell cycle phase DNA analysis demonstrated Lupron caused a reversible 5-6% increase in the portion of cells in rest phase, G0/G1, compared to controls during log growth, and a corresponding decrease in the portion of cells in DNA synthesis, S phase. However, long-term culture, 3 weeks, with Lupron failed to arrest cells in G0/G1, and experimental cultures plateaued at cell number similar to control cultures. We conclude Lupron's effect on ovarian cancer cell proliferation is independent of gonadotropin and steroid, involves a cell cycle regulatory event, and duration of benefit observed in vivo for some patients may be related to total tumor volume at the time of treatment.

Antineoplastic Agents↗
PubMed1991

Recurrent necrotizing fasciitis of the vulva. A case report.

Necrotizing fasciitis most often occurs in the context of prior trauma or surgery. Predisposing medical conditions include diabetes mellitus, arteriosclerosis, obesity, hypertension and prior irradiation. De novo occurrence in the vulva, in the absence of prior injury, surgery or irradiation, has been reported rarely. Necrotizing fasciitis of the vulva in the diabetic patient may have an insidious onset but requires an early diagnosis and aggressive surgical episode of fasciitis occurred in an obese, diabetic woman. Aggressive, wide excision of all infected vulvar, mons and thigh tissue, followed by aggressive medical and surgical postoperative care, resulted in minimal morbidity. Prompt recognition and aggressive care are required to treat this condition.

Adult↗
PubMed1991

Use of the intestinal isolation bag in gynecologic surgery.

Exposure of the operative site during laparotomy is, at times, suboptimal. The major viscera requiring retraction out of the operative field are the small intestines. Usually, multiple cloth laparotomy packs are used to compress and displace the intestines. We describe the use of an intestinal isolation bag to house the small intestines and keep them out of the operative field. Using this technique, laparotomy packs are not required. Because the bag itself takes up very little space, the size of the operating field is not compromised. In addition, the bag does not abrade or desiccate the bowel, potentially reducing serosal injury and adhesion formation.

Female↗
PubMed1990

Phase II trial of vinblastine in advanced ovarian carcinoma. A Gynecologic Oncology Group study.

A phase II trial of vinblastine in patients with refractory epithelial ovarian adenocarcinoma of the ovary was conducted by the Gynecologic Oncology Group (GOG) between March 9, 1988 and July 7, 1988. Vinblastine was administered in a dose of 9 mg/m2 intravenously every three weeks until disease progression or toxicity supervened. Twenty patients were entered initially. One was ineligible due to a previous primary cancer. Thus, 19 patients are evaluable for toxicity and response. All patients had cisplatin-combination chemotherapy and four had prior radiotherapy. Median age was 63 years (range 40-75 years). Thirteen patients had disease in the pelvis and six had extrapelvic metastases. Ten patients had grade 3 lesions and seven had grade 2. A median of two courses (range: 1-6) were administered. Toxicity was moderate. Seven patients (36.8%) experienced GOG grade 3 or 4 leukocytopenia and six had grade 3 or 4 granulocytopenia. Median nadir WBC was 2,000 cells/microliters (range 600-3,500) and platelet nadirs for the three patients with thrombocytopenia were 60,000, 116,000, and 147,000. Other toxicity included grade 3 gastrointestinal and renal toxicity in one patient each. Seven patients (36.8%) had stable disease on therapy and 12 had increasing disease. No responses were observed. Vinblastine in this dose and schedule is inactive in patients with resistant epithelial ovarian adenocarcinoma progressing on first-line chemotherapy.

Adenocarcinoma↗
PubMed1990

Laser vaporization of genital condylomata in pregnancy.

Sixteen pregnant women with genital condylomata acuminata were treated with laser vaporization to assess effectiveness, complication rate, and impact on recurrence. Patients were treated at a gestational age of 13-35 weeks. No recurrences occurred before delivery. Five patients experienced uterine contractions before 37 weeks. Only one delivery before 37 weeks may have been attributed to the laser therapy. Four recurrences were detected during postpartum follow-up. Laser vaporization is a safe and effective treatment for condyloma during pregnancy. It is effective in maintaining a lesion-free state during pregnancy, but postpartum recurrences are not rare.

Adolescent↗
PubMed1990

Echinomycin (NSC 526417) in advanced ovarian cancer. A phase II trial of the Gynecologic Oncology Group.

Twenty-two patients with recurrent carcinoma of the ovary progressive after initial chemotherapy (21 with cisplatin-based treatment) were entered on a phase II trial utilizing Echinomycin at a dosage of 1,500 micrograms/m2 every 4 weeks. There were two complete responders and no partial responders (9% response, 95% confidence intervals for complete and partial responses of 1-29%). Major toxicity was modest and consisted mainly of nausea and vomiting. Echinomycin displays minimal activity as salvage therapy in women with advanced ovarian cancer at this dose and schedule.

Adult↗
PubMed1990

Herpes simplex and human papillomavirus genital infections: controversy over obstetric management.

Plasma inhibitory factors, high levels of sex hormones, and depression of cell-mediated immunity may interfere with the natural host resistance to viral infections during pregnancy. It is apparent that hormonal, immunologic, and vascular changes in pregnancy may account for increased replication of herpes and for enhanced growth of condylomatous lesions. The challenge is to develop a rational plan of management for pregnant patients with herpes simplex or human papilloma virus infection. There has been a reevaluation of previous recommendations for the management of herpes in pregnancy. Although the consequences of neonatal infection are severe or fatal, the value of routine weekly screening is questionable. This regimen is a poor predictor of neonatal exposure to herpes since only one fourth of women shedding virus at the time of delivery can be identified by routine cultures. The mode of delivery should therefore be based on the presence or absence of lesions at the time of confinement. Cesarean section should be reserved for patients with lesions or with prodromal symptoms of recurrent disease at the time of delivery. Patients with ruptured membranes and active genital lesions should also be delivered by cesarean section. The spectrum of HPV-related diseases in pregnancy is poorly understood. Many questions remain unanswered. It may not be practical to treat very large or extensive genital warts during pregnancy. A cesarean section may be the best choice in these cases. It may be premature to recommend cesarean section for delivery of all pregnant women with symptomatic genital HPV infection. More data are needed. We recommend laser ablation of condylomatous lesions when discovered during pregnancy. Laser vaporization is associated with minimal morbidity when used by experienced surgeons. Trichloroacetic acid is excellent for minimal disease or for treatment of recurrences in pregnancy. Since the immune system seems to play an important role in control of viral disease, we advise pregnant patients to adopt a lifestyle which promotes health. We advise a balanced diet, an appropriate exercise program, and an environment free of unnecessary stress. We suggest avoidance of cigarettes, drugs, and alcohol.

Female↗
PubMed1989

Appraising a clinical journal article in obstetrics and gynecology.

Although some physicians have the opportunity to participate in a journal club during residency, many infrequently receive formal instruction on how to critically evaluate a journal article. Systematic guidelines for appraising a clinical journal article are presented and illustrated with examples. Considering each guideline in its respective order may lead to a better understanding of what the literature may offer one's practice.

Female↗
PubMed1989

Quantitative evaluation of the skin and accessory appendages in vulvar carcinoma in situ.

Fifty cases of vulvar carcinoma in situ comprising over 1000 histologic sections were studied. Each case was evaluated to determine the thickness of the neoplastic epidermis and the depth of involved skin appendages. Two precise techniques were used to perform the microscopic measurements. The areas most frequently afflicted with neoplasia were: one or both labia (45%), interlabial folds (27%), perineum-fourchette (15%), and perianal skin (10%). Multicentric disease was observed in 68% of the cases. The epidermal thickness ranged between 0.35-1.66 mm. The mean depth (+/- SD) of the epidermis was 0.93 +/- 0.37 mm. Eighteen of the 50 patients demonstrated involvement of the skin appendages to a mean depth of 1.53 +/- 0.77 mm, suggesting that laser vaporization to a depth of 2.5 mm will, with the anticipated additional thermal necrosis, eliminate appendages involved with carcinoma in situ in 95% of instances. The most common sites of skin appendage involvement were the labia majora or minora and the interlabial folds.

Adult↗
PubMed1988

Aromatization of testosterone by epithelial tumor cells cultured from patients with ovarian carcinoma.

Ovarian epithelial carcinoma originates from the surface mesothelium. It is controversial whether these tumors possess steroidogenic enzymes, similar to malignancies of other ovarian cell types. This study reports aromatase enzymatic activity for three epithelial cell lines, OV1225, OV166, and 2774, established from patients with ovarian adenocarcinoma. Aneuploidy of the cells was demonstrated by flow cytometric DNA analyses which showed OV1225 tetraploid, OV166 near diploid, and 2774 triploid. Estrogen synthesis was confirmed by measurement of estradiol (6 to 11 pg/10(7) cells/24 h) by radioimmunoassay in extracts of conditioned medium. To directly assay aromatase enzymatic activity, intact cells were incubated with tritiated testosterone. Medium was extracted with organic solvent after addition of trace 14C-labeled 17 beta-estradiol and 14C-labeled estrone. Androgen was separated from estrogen by celite column chromatography. Estrogen was further purified by silica gel thin-layer chromatography and derivatization of separate products to acetates. Purity of compounds was confirmed by consistency of the 3H:14C ratio of acetylated product versus that of product recrystallized with authentic standard. Conversion of testosterone to estradiol proceeded with apparent Michaelis-Menten kinetics. The apparent Km was 4 microM, 15 microM, and 59 microM, and the Vmax was 20 pmol/h/mg of cell protein, 52 pmol/h/mg of cell protein, and 152 pmol/h/mg of cell protein for 2774, OV166, and OV1225, respectively. We conclude that at least a portion of ovarian adenocarcinoma possesses sufficient aromatase activity to convert ovarian stromal androgen to estrogen.

Aromatase↗
PubMed1988

Combined tubal and molar pregnancy: case report.

A patient with combined pregnancy developed an acute condition in the abdomen 9 weeks after surgical removal of a tubal pregnancy. At laparotomy she was found to have bilateral theca-lutein cysts. After operation, the patient went into preterm labor and was delivered of a male fetus. Pathologic examination of the placenta revealed hydropic change and trophoblastic hyperplasia.

Adult↗
PubMed1988

Emergence of imipenem-resistant Pseudomonas aeruginosa during treatment of intra-abdominal infection in a patient with ovarian carcinoma.

A 59-year-old woman was admitted to the hospital with ovarian carcinoma. After cytoreductive surgery, the patient developed intra-abdominal sepsis. After 17 days of intravenous imipenem, the patient's sputum culture grew imipenem-resistant Pseudomonas aeruginosa. On the 21st day of treatment with imipenem, her peritoneal culture also grew imipenem-resistant Pseudomonas aeruginosa.

Abdomen↗