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Biomedical subjects

M Maiman

Publications and source records attributed to M Maiman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Complications after treatment of cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus.

OBJECTIVE: To compare the frequency of complications after treatment of cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus (HIV)-infected and -seronegative women in an ambulatory setting. STUDY DESIGN: A retrospective record review of 15 HIV-infected and 44 HIV-negative women treated by laser therapy or cone biopsy and retrospective interviews of 20 HIV-infected and 44 HIV-negative women treated by cryotherapy. RESULTS: Four of 35 (11%) HIV-infected women had excessive bleeding after laser/cone or cryotherapy as compared to one of 88 (1%) HIV-negative women (odds ratio 11.27, P = .02). After laser/cone therapy, significantly more HIV-infected women (53%) had cervicovaginal infections than did HIV-negative women (18%). A higher prevalence of infection was associated with more severe immunodeficiency. CONCLUSION: HIV-infected women are vulnerable to complications after treatment of CIN and should be monitored closely.

Cryosurgery↗
PubMed1994

The adequacy of cytology and colposcopy in diagnosing cervical neoplasia in HIV-seropositive women.

The purpose of this study was to compare cytology and colposcopy as predictors of cervical intraepithelial neoplasia (CIN) in women infected with the human immunodeficiency virus (HIV). A cross-sectional analysis of cytology, colposcopy, and colposcopic biopsy results from 51 HIV-seropositive women attending an ambulatory HIV service was conducted. Cytology slides were reviewed by two cytopathologists blinded to patients' HIV status. There was strong agreement in the readings of two cytopathologists, with a kappa score of 0.9. Of 29 women with normal cytology, 21 (72%) had pathology on histology, including 7 (24%) with CIN. Colposcopic impression correlated well with histology results. Of 22 women with abnormal cytology, 82% had abnormal histology. The overall prevalence of CIN was high at 45%, increasing from 35% in women with CD4 counts over 400 to 56% in women with CD4 counts below 200. In conclusion, screening cytology is limited by false-negative results; routine colposcopy should be considered in this high-risk population.

Adult↗
PubMed1994

Characteristics of cervical intraepithelial neoplasia in women infected with the human immunodeficiency virus.

OBJECTIVE: Our purpose was to compare characteristics of cervical intraepithelial neoplasia in relation to human immunodeficiency virus infection among women referred to a public hospital colposcopy clinic with Papanicolaou smears showing cervical intraepithelial neoplasia. STUDY DESIGN: An evaluation of cervical intraepithelial neoplasia severity, lesion size, and vulvovaginal lesions with respect to human immunodeficiency virus status was performed. RESULTS: (1) Human immunodeficiency virus prevalence in 482 women with cytologic characteristics of cervical intraepithelial neoplasia was 13%. (2) In human immunodeficiency virus-infected patients, Papanicolaou smears were less adequate for evaluation and correlated less well with histologic findings than in uninfected patients (p < 0.05). (3) Human immunodeficiency virus-infected patients (n = 47) had more advanced cervical intraepithelial neoplasia, larger cervical lesions, and more associated vulvovaginal lesions than human immunodeficiency virus-negative patients (n = 161). In human immunodeficiency virus-positive women, the severity of cervical intraepithelial neoplasia was not associated with age, whereas in human immunodeficiency virus-negative women, increasing severity was significantly associated with increasing age. CONCLUSION: High rates of human immunodeficiency virus infection in inner-city colposcopy services and high-grade, extensive cervical lesions in infected women warrant special attention.

Adult↗
PubMed1994

Cervical neoplasia in women with HIV infection.

HIV infections in women now account for 40% of all HIV infections worldwide, and the majority of new infections are due to heterosexual transmission. In the United States, 12% of AIDS cases occur in women and in certain high prevalence areas such as Brooklyn, New York, 25% of cases are in women. Both squamous cell neoplasia of the cervix and HIV infection are, in part, sexually transmitted diseases, with oncogenic types of human papillomavirus infection the implicated viral carcinogen associated with cervical cancer. Therefore, an association between cervical cancer and AIDS can be anticipated on the basis of common sexual behavioral risk factors. The author summarizes what we know about the diagnosis and management of women with these problems.

Carcinoma, Squamous Cell↗
PubMed1993

Human immunodeficiency virus infection and invasive cervical carcinoma.

BACKGROUND AND METHODS: To determine the relationship between cervical cancer and human immunodeficiency virus (HIV) infection, 84 women of known HIV status with invasive cervical carcinoma were assessed. Sixteen of 84 patients (19%) were HIV seropositive. The disease characteristics, recurrence rates, survival rates, and immune status of 16 seropositive and 68 seronegative women were compared. RESULTS: HIV-infected women with cervical cancer had significantly more advanced disease than those who were not infected with the virus. Only 1 of 16 (6%) HIV-infected women had early-stage surgical pathologic disease compared with 40% in the HIV-negative group. The response to therapy and prognosis were poorer among HIV-infected women, with higher recurrence and death rates compared with uninfected women. The mean CD4 counts, CD4:CD8 ratios, and percentage of CD4 cells were 360/mm3, 0.57, and 26.8% in HIV-infected women compared with 830/mm3, 1.71, and 41.2% in HIV-negative group. The patient's immune status had a significant impact on subsequent disease because only seropositive patients with CD4 counts greater than 500/mm3 had prolonged or disease-free follow-up. Surgery was performed safely in patients with relatively good immune function. CONCLUSIONS: HIV-infected women represent a unique subset of patients with cervical carcinoma that have more aggressive disease and a poorer prognosis. However, positive serostatus alone does not uniformly confer an unfavorable outcome because patients with initial adequate immune status may do well. HIV testing is recommended in all relatively young women with cervical cancer, and unique therapeutic strategies are advocated in women with these two potentially fatal diseases.

Adenocarcinoma↗
PubMed1993

Unilateral single vaginal ectopic ureter with ipsilateral hypoplastic pelvic kidney and bicornuate uterus.

We report on 2 patients with a unilateral vaginal ectopic ureter associated with a single system, ipsilateral hypoplastic pelvic kidney and bicornuate uterus. Although there are many reports of concomitant urinary and reproductive system malformations, a review of the literature shows these unique associations in the same patient to be extremely rare. These findings provide further evidence of the intricate interaction between mesonephric (wolffian) and paramesonephric (müllerian) ducts in the development of the urogenital system. Embryological aspects as well as clinical presentation, diagnostic approach and treatment applicable to this group are discussed.

Adolescent↗
PubMed1993

Recurrent cervical intraepithelial neoplasia in human immunodeficiency virus-seropositive women.

OBJECTIVE: To determine the effect of human immunodeficiency virus (HIV) infection on the rate of recurrence of cervical intraepithelial neoplasia (CIN) after standard ablative therapy, and to correlate the degree of immunosuppression with treatment results. METHODS: The clinical courses of 44 HIV-positive women with CIN were compared with those of 125 HIV-negative women. Patients were treated with cryotherapy, laser therapy, or cone biopsy per standard indications and were followed with cytology at regular intervals, with a range of follow-up of 3-43 months. RESULTS: Seventeen of 44 HIV-positive women (39%) developed biopsy-proven recurrent CIN, compared to 11 of 125 HIV-negative women (9%) (P < .01). The distributions of CIN severity, lesion size, and modality of treatment were similar in the two groups. In HIV-negative patients, recurrent CIN was associated with increasing grade, but in HIV-positive patients, recurrence was related to increasing immunosuppression. The mean CD4 count in HIV-positive patients with recurrence was 239/mm3, compared to 367/mm3 in HIV-positive patients who remained free of CIN. Only 18% of HIV-positive patients with CD4 counts over 500/mm3 had recurrence, compared to 45% of those with CD4 counts under 500. There was a trend toward poorer treatment results with the use of cryotherapy in HIV-positive patients. All recurrences occurred in patients whose mode of acquisition of HIV was heterosexual transmission. CONCLUSION: Recurrence rates of CIN after standard treatment in HIV-positive women are high, and recurrence is related to immune status in this high-risk group. Therapeutic strategies that address these treatment failures should be developed for HIV-seropositive women.

Adult↗
PubMed1992

Radical hysterectomy for cervical cancer: morbidity and survival in relation to weight and age.

The records of 123 patients with Stage I cervical cancer who underwent radical hysterectomy with pelvic lymphadenectomy and para-aortic node sampling from 1981 to 1988 were reviewed to assess the risks of surgery associated with increasing weight and age. Fifty-four patients were obese (20% or more over ideal body weight) and fourteen were elderly (age 65 or older). Previous abdominal/pelvic surgery and operative time were significantly increased in the obese patients (P less than 0.05). Increased weight was associated with increased blood loss (P = 0.06). Medical illnesses, transfusion rates, postoperative stay, intraoperative and postoperative complications (including wound infection and separation), long-term complications, and 5-year survival rates were not significantly different in obese and nonobese women. Diabetes mellitus, hypertension, any medical illness, intraoperative complications (29% vs 3%), and postoperative ileus were significantly higher (P less than 0.05) in elderly patients. However, operative time, blood loss, transfusion rates, postoperative stay, postoperative complications (exclusive of ileus), long-term complications (13-21%), and 5-year survival rates (77-99%) were not significantly different when analyzed by age. We found no significant increase in morbidity of radical hysterectomy for Stage I cervical cancer in the obese patient and minimally increased morbidity in the elderly patient with no increase in long-term complications or decrease in survival. Obesity should not represent a contraindication to radical surgery in appropriately selected patients with cervical cancer.

Aging↗
PubMed1991

The accuracy of frozen section in the diagnosis of ovarian neoplasms.

In a retrospective study to determine the accuracy of frozen section diagnoses in ovarian neoplasms, the results of consecutive frozen section diagnoses of 311 ovarian neoplasms from two institutions, New York University Medical Center and State University of New York Medical Center at Brooklyn, from 1980 through 1989 were compared with the final diagnosis results following extensive sampling on permanent sections. The final diagnosis was assumed to be correct for purposes of this study. Ovarian neoplasms were correctly diagnosed on frozen section as either benign or malignant in 292 patients (accuracy of 93.8%). Frozen section diagnoses were incorrect in 11 patients (3.5%). Frozen section diagnosis was deferred in 8 instances (2.6%). The positive predictive value was 100%. The negative predictive value was 95.3%, specificity 100%, and sensitivity 86%. There were no false positives. Of the 11 false negative frozen section diagnoses, 9 (82%) were due to limited sampling for frozen section. We therefore suggest that careful examination with sampling of any suspicious lesions be carried out at the time of surgery for patients with benign frozen section diagnosis, since this may avoid a second staging laparotomy, if the final diagnosis is malignant.

Carcinoma, Squamous Cell↗
PubMed1991

Selection for percutaneous nephrostomy in gynecologic cancer patients.

For patients with gynecologic cancers who present with ureteral obstruction, it is often difficult to determine whether intervention with nephrostomy tube is appropriate. This study was designed to determine if evaluation prior to percutaneous nephrostomy could accurately predict patients who would benefit from intervention. Twenty-two gynecologic cancer patients with bilateral ureteral obstruction were evaluated. Criteria contraindicating intervention included disease progression while on therapy, potentially life-threatening medical problems, Zubrod performance status greater than 2, no available efficacious therapy, noncompliance, and poor pain control. A single criterion was sufficient to contradindicate percutaneous nephrostomy placement. Including replacement nephrostomies, a total of 46 percutaneous nephrostomies and four stents were placed in 19 patients. Three patients had no intervention. Only 9 patients did not have any contradictions to placement of percutaneous nephrostomy, based on predictive criteria. Patients without contraindications to percutaneous nephrostomy survived longer (median days, 242 versus 37; P less than 0.05), had improved quality of life (median days at home, 164 versus 2; P less than 0.05), and had a better chance of receiving therapy after percutaneous nephrostomy (9 versus 2 patients; P less than 0.05). Assessment prior to percutaneous nephrostomy maybe helpful in guiding the physician in recommending intervention.

Combined Modality Therapy↗
PubMed1991

Colposcopic evaluation of human immunodeficiency virus-seropositive women.

To determine the effect of human immunodeficiency virus (HIV) infection on cervical histology, 32 known HIV-seropositive women underwent cervical colposcopic evaluation. All had cervical cytology, colposcopically directed biopsy, and T-cell studies performed. Thirteen of 32 patients (41%) had cervical intraepithelial neoplasia (CIN). Another 14 of 32 patients (44%) had histologic evidence of cervicitis. Abnormal cytology, noted in only three women, suggested CIN in one and inflammatory atypia in two. All (five of five) patients with a clinical diagnosis of AIDS had CIN, compared with 30% (eight of 27) of non-AIDS HIV-positive patients (P less than .05). Patients diagnosed with CIN had significantly lower CD4 cell counts (221/mm3 versus 408/mm3; P less than .06) and CD4:CD8 ratios (0.33 versus 0.62; P less than .02) than those without CIN. Patients with cervicitis had greater T-cell immunosuppression than did those with normal histology. In addition, patients with AIDS were more likely to have higher-grade lesions than were non-AIDS HIV-seropositive patients. Seven of 12 CIN specimens available for analysis by polymerase chain reaction using consensus sequence primers detected human papillomavirus (HPV) DNA, including three patients with three or more HPV types. Our data suggest that abnormal cervical pathology is common among HIV-positive women and that cytologic screening is not predictive of CIN in this population. In addition, the presence and severity of cervical dysplasia correlates with quantitative T-cell function. We strongly recommend that cervical colposcopy be part of the routine management of HIV-seropositive women.

Adult↗
PubMed1991

Laparoscopic excision of ovarian neoplasms subsequently found to be malignant.

One hundred fifty-six members and candidate members of the Society of Gynecologic Oncologists responded to a survey concerning the "laparoscopic management of ovarian neoplasms subsequently found to be malignant." Twenty-nine responders (19%) reported a total of 42 cases of ovarian malignancy. The laparoscopic procedure was aborted or the cyst was aspirated in 38% of the cases, and partial or complete excisions were attempted in 33 and 29%, respectively. The characteristics of the masses were as follows: less than 8 cm 67%, cystic 62%, unilocular 48%, and unilateral 81%. All four "benign" characteristics were present in 31% of the cases found to be malignant, and three of four characteristics were present in 24%. Laparotomy was performed at the time of laparoscopy in 17% of cases, after laparoscopy in 71% with an average interval of 4.8 weeks, and not at all in 12%. Fifty-seven percent of the cases were invasive epithelial malignancies, whereas 29% were tumors of low malignant potential. At least 50% of the patients had stages II-IV. We conclude that attempted laparoscopic excisions of adnexal masses that are subsequently found to be malignant are not uncommon, and that the presence of so-called "benign" characteristics does not preclude malignancy. Attempts at partial or complete excision are common, as are delays in subsequent definitive surgery. The stage of disease is often advanced, and all histologic types of malignancy are encountered. We advocate careful evaluation of this practice, with development of strict guidelines to ensure optimal patient care.

Female↗
PubMed1990

Human immunodeficiency virus infection and cervical neoplasia.

To determine the relationship between human immunodeficiency virus (HIV) infection and cervical neoplasia, the characteristics of invasive and preinvasive cervical disease in 114 patients of known HIV status were assessed. Seven of thirty-seven patients (19%) under age 50 with invasive cervical carcinoma were HIV-positive, including a 16-year-old with stage IIIB disease. HIV-positive patients had more advanced invasive cancer than HIV-negative patients. Disease persisted or recurred in all HIV-positive patients compared to 37% of HIV-negative patients. In HIV-positive patients, the median times to recurrence and death were 1 and 10 months, respectively. No HIV-positive patient had HIV-related symptoms. The mean T4:T8 cell ratio in HIV-positive patients was 0.49, compared to 1.86 in HIV-negative patients. The mean T4 cell count was 362/mm3 in HIV-positive and 775/mm3 in HIV-negative patients. Colposcopic evaluations of the lower genital tract of 77 patients with abnormal smears revealed higher-grade cytology and histology in 25 HIV-positive than in 52 HIV-negative patients. HIV-positive patients had significantly more multifocal/extensive lesions, multisite involvement, perianal involvement, evidence of human papillomavirus (HPV) infection, and associated gynecologic infections than HIV-negative patients. In areas at high risk for HIV infection, we must anticipate a high prevalence of HIV seropositivity in women with invasive cervical cancer. In the HIV-infected, cervical cancer is of advanced stage and responds poorly to therapy. Intraepithelial neoplasia in HIV-positive patients may be of higher grade than in HIV-negative patients, with more extensive involvement of the lower genital tract.

Adolescent↗
PubMed1990

The fallacy of the screening interval for cervical smears.

One hundred seventy-four women with invasive cervical carcinoma were interviewed about their cervical smear histories to assess the accuracy of self-reporting and to relate the smear history with patient and tumor characteristics. Patients reported significantly more frequent, more recent, and more normal smears than were documented in medical records. The interval between onset of cancer symptoms and previous smear correlated directly with advanced stage. Sixteen women with normal smears within 36 months had significantly more advanced cancers than did 25 women with recent abnormal smears. Women with recent normal and abnormal smears had similar sociodemographic and behavioral characteristics. Because of inaccuracies in patients' self-reported smear histories and cancers developing in women with recent normal smears, we conclude that a specific screening interval should not be relied upon.

Female↗
PubMed1989

Value of squamous cell carcinoma antigen levels in invasive cervical carcinoma.

Squamous cell carcinoma (SCC) antigen (Ag) levels were measured by radioimmunoassay in 64 patients with invasive squamous cell cervical carcinoma and 9 patients with nonsquamous carcinoma before the initiation of treatment. The mean antigen level in the squamous group was 10.5 ng/ml compared with 1.3 ng/ml in the nonsquamous group. In the patients with squamous cell carcinoma, mean SCC Ag level correlated well with stage, except for bulky stage IB tumors (P less than 0.05), where mean level was much higher than expected. Patients with exophytic tumors had significantly higher SCC Ag levels than those with nonexophytic tumors. Follow-up on 62 evaluable patients ranged from 20 to 40 months. The mean pretreatment SCC Ag level for patients free of disease at last contact was 5.6 ng/ml, in contrast to 16.1 ng/ml for those with recurrent disease. Only 32% of patients free of disease had pretreatment levels of 4.0 ng/ml or greater, while 86% of those with recurrent disease had such values (P less than 0.05). Forty patients had follow-up samples drawn 1 to 14 months after treatment. Mean post-treatment SCC Ag levels dropped to 1.8 ng/ml in 21 patients free of disease (73% decrease), but remained elevated at 13.4 ng/ml (17% decrease) in 19 patients with recurrences. The specificity of follow-up SCC Ag levels as a predictive test for outcome was 90%, with a sensitivity of 63%. We conclude that pretreatment SCC Ag levels correlate well with tumor stage, lesion morphology, and extent of disease. SCC antigen levels may be used to follow patients to determine effectiveness of treatment.

Adult↗
PubMed1988

Predictive value of computerized tomography in the presurgical evaluation of primary carcinoma of the cervix.

To determine the predictive value of abdominal-pelvic CT scan in assessing pelvic and paraaortic node metastases in untreated cervical carcinoma, the preoperative CT scans of 61 patients were compared with the gross and microscopic surgical findings. Although 75% of enlarged pelvic nodes on CT contained metastases, and 97% of patients with negative pelvic nodes had negative CT scans (specificity = 97%), histologically positive pelvic nodes were often missed on CT scan (sensitivity = 25%). For paraaortic nodes the CT scan had a specificity of 100% and a sensitivity of 67%. No paraaortic nodes were enlarged in stages I-IIA (0/51). CT scans are recommended for routine evaluation of paraaortic nodes in stages II-IV, but are not warranted in pretreatment evaluation of the pelvic nodes in stage I.

Carcinoma↗