Biomedical subjects
Publications and source records attributed to M Glezerman.
Fibrolamellar carcinoma of the liver is a rare tumor that has not been previously reported to occur during pregnancy. A 22-year-old, pregnant Arab woman with documented fibrolamellar carcinoma of the liver was followed at our high-risk pregnancy unit. Despite the severity of the disease, the pregnancy and delivery were uneventful.
Several lines of evidence support the view that premature rupture of the membranes and premature labor are associated with bacterial infection of the amniotic cavity. The standard method of diagnosing intraamniotic infection is amniotic fluid culture, but the results become available only after 72 hours. Methods for more rapid diagnosis of bacterial invasion are therefor needed. We examined leukocyte esterase activity for this purpose. Amniotic fluid obtained from 62 women in preterm labor was cultured for aerobic, anaerobic and mycoplasma species. Leukocyte esterase activity was measured with a Bio-dynamics test strip. The sensitivity of the test was 50.0% and its specificity 93.4%. It was found to be a simple and rapid method for the detection of intraamniotic infection.
Twenty-six patients with epithelial ovarian carcinoma, were treated by cisplatinum--containing combination chemotherapy following initial laparotomy. The mean number of treatment cycles was 7.8 (median: 9). The mean dose intensity (DI) and mean relative dose intensity (RDI) respectively were for cyclophosphamide: 108 mg/m2/week and 0.65, for doxorubicin: 8.6 mg/m2/week and 0.51, and for cisplatinum: 9.8 mg/m2 week and 0.59. The mean average relative dose intensity (ARDI) was 0.53. The three-year survival for all patients was 43%. No statistically significant difference in the three-year survival between patients receiving RDI's and ARDI of less than median dose and those receiving RDI's and ARDI of more than median dose could be demonstrated. Larger series are needed to test whether, and to what extent, dose intensity contributes to outcome, independently of the total amount of drug given.
19 women and 9 men, aged 15-59 (mean, 35.1), who had had recurrent lip or genital infections with herpes virus (HSV) for from 1-38 years, were treated with beta-interferon gel (100,000 IU/g), self-administered 4 times daily to the affected areas. In half the patients the drug and a placebo were given in a double-blind, cross-over study. The trial lasted 30 months. Frequency of attacks, length of each attack and its severity, and the presence of itching were noted. If there was improvement in at least 2 parameters treatment was considered successful. This was the case in about 75% of the patients. The mean number of attacks per year before and during treatment with interferon was 6.8 and 3.0, respectively (p less than 0.003) and the mean length of attacks 8.2 and 4.7 days, respectively (p less than 0.001). Results of the double-blind, cross-over test were also significant, and were similar to those for the total group. These results clearly indicate that local interferon is effective treatment for genital and labial HSV infections.
We reviewed the records of 110 consecutive patients with advanced-stage epithelial ovarian carcinoma treated at the Soroka Medical Center, Beer-Sheva, Israel, from 1961-1987. Twenty patients (18.1%) had optimal debulking at initial laparotomy, 30 patients (27.2%) had nonoptimal debulking at initial laparotomy, 20 patients (18.1%) had an "inoperable" disease at initial laparotomy, and 40 patients (36.3%) had such poorly written records that no information about the degree of resectability at initial laparotomy could be obtained. Four patients, in whom the residual tumor left at initial laparotomy had responded to chemotherapy, had a second laparotomy. In all four patients optimal debulking surgery at second laparotomy was easy to perform and was successful. The value of a second laparotomy after a few cycles of chemotherapy in order to optimally debulk the residual tumor left at initial laparotomy is discussed. It is concluded that a second attempt of debulking surgery after chemotherapy has a respectable place in the management of patients with advanced-state epithelial ovarian carcinoma, but further research is needed.
Because of the known low incidence rate of cervical cancer in Jewish women, less than appropriate attention has been focused on this type of malignancy in Jewesses. We have summarized our experience with 144 cases of cervical cancer diagnosed during 25 years in South Israel. In recent years a remarkable, although not statistically significant, increase in the number of patients with cervical cancer could be observed. Only two of ten patients were diagnosed at preinvasive stage. In contrast with previous reports we did not find women of Asian and African origin to be overrepresented, but patients from these origins were more often diagnosed at a higher stage than were patients of European origin. Adenocarcinoma accounts for almost 19% of the cervical cancer in premenopausal women. A very low rate of early detection of cervical cancer and a trend of rising incidence of cervical cancer in Jewish women urgently require a reevaluation of health care policy. Large-scale screening programs, perhaps initially in defined high-risk groups are needed.
Five cases of synchronous carcinomas of uterine endometrium and ovary are reported. All uterine cancers were typical endometrial adenocarcinomas. Among the ovarian cancers, four were serous papillary cystadenocarcinomas and one was an endometrioid carcinoma. There is much controversy with respect to staging and management of such cases since these tumors may represent either two synchronously occurring primaries or a single primary with metastases. It is suggested that when each tumor is confined within the limits of its tissue of origin the tumors may be considered as two separate primaries and surgery may be less aggressive. When there is evidence that at least one tumor is spreading to adjacent tissues and organs the question of two separate primaries or one metastatic tumor becomes academic only and aggressive surgical treatment with adjuvant chemotherapy is indicated.
A case of proliferating trichilemmal tumor, otherwise known as pilar tumor, occurring in the dermis of the left labium majus of a 65-year-old woman, is presented. To our knowledge, this is the second reported case of such a tumor occurring in this location. The origin of this neoplasm, the reasons for its rarity at this site, and the range of its biological behavior are discussed in relation to the clinical manifestations of this case.
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The efficacy of topical interferon-beta (IFN-beta) treatment was assessed in 25 patients with herpes of the lips or genitals who completed a 2-year follow-up in a double-blind placebo-controlled trial. IFN-beta gel (10(5) U/g) 4 times daily (about 2 x 10(4) U) applied locally during eruptions (about 10 days) reduced the mean number of recurrences (p less than 0.007) and the duration of eruptions (p less than 0.007): in the placebo group these indices did not change significantly. Reduction of symptoms and severity was noted in 11 of 12 patients on IFN-beta and in only 1 on placebo. No important side-effects were recorded. Topical IFN-beta may therefore be advantageous as a time-limited local treatment of recurrent herpes simplex virus infections of the genitals and lips.
This study was undertaken to investigate the presence of antisperm antibodies (ASA) in serum, cervical mucus, and follicular fluid (FF) of women undergoing in vitro fertilization and embryo transfer (IVF-ET). IgG and IgA ASA directed mostly against sperm head were found at similar concentrations in serum, cervical mucus, and FF of 2 of 34 patients. Ninety-one percent fertilization and 100% cleavage rates, respectively, were observed in one of the two patients. No fertilization occurred in the second patient. In both women, in vitro sperm penetration tests revealed hostile mucus and repeated postcoital tests were poor. It is concluded that the sperm-cervical mucus penetration test and mucus ASA measurements are useful in establishing the diagnosis of immunological infertility.
Classification of ovarian tumors according to FIGO does not take into account involvement of spleen. A patient who appears to be the first reported case of widespread carcinoma of the ovary with involvement of the splenic parenchyma is presented.
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Considerable evidence indicates that changes in acid phosphatase (AP) activity at the ovarian level play a role in the process of ovulation. In this study the concentrations of AP were determined in follicular fluids collected from follicles of 52 women at the time of laparoscopy performed in connection with an in vitro fertilization program. In each of the 52 women at least one ovum was harvested. Of the 52 ova, 28 cleaved in vitro, while in 24 ova cleavage was not seen. Levels of AP in follicular fluids of women whose ova did not cleave were significantly lower than those found in follicular fluids of women with at least one ovum undergoing cleavage: 0.45 +/- 0.14 (SE) and 4.78 +/- 0.37 Bess Lowry Units (BLU), respectively. Comparison of AP levels in follicular fluids of women who conceived (5) and women whose ova cleaved, but in whom pregnancy was not achieved (23), did not reveal significant differences: 5.87 +/- 1.29 and 4.55 +/- 0.35 BLU, respectively. Moreover, the enzyme level was typical for a woman and not for a follicle. Fluids of two different follicles of the same woman, when one ovum cleaved and one did not, showed similar AP levels. AP levels were high in all samples follicles of women in whom at least one ovum cleaved. These findings indicate that the presence of certain levels of acid phosphatase represents an important, albeit not the sole, condition for ovum maturation. Moreover, the follicular fluid levels of AP could serve as an indicator of proper timing of the follicular puncture in relation to the human chorionic gonadotropin injection (or the luteinizing hormone peak).
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A 16-year-old girl presented with a large pelvic mass. At laparotomy, bilateral ovarian tumors were disclosed and bilateral salpingo-oophorectomy was performed. No evidence of extra-ovarian disease was found. Histopathological examination and histochemical immunoperoxidase studies demonstrated the tumors to be malignant lymphoma of the lymphoblastic type. The patient had radiotherapy and systemic chemotherapy and more than 10 years later she is alive with no evidence of recurrent disease. The rarity of ovarian involvement as the initial manifestation of malignant lymphoma is discussed. The question of whether this patient represents a case of a primary ovarian malignant lymphoma or merely represents a case of ovarian initial manifestation of an occult generalized disease cannot be answered.
An ambulatory set-up is presented which comprises a simple armamentarium for management of women complaining of urinary stress incontinence. Since history appeared to be not sufficiently reliable for management of patients, diagnosis was based mainly on cystomanometry and radiology. Of 58 women who have completed at least six months of follow-up, 11 had been diagnosed as suffering from detrusor instability (DI) and 47 from genuine stress incontinence (SI). Treatment was medical in the former group and surgical in the latter. Significant or complete relief of symptoms was reported in 91% of the former group and in 81% in the latter.