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S Berkman

Publications and source records attributed to S Berkman.

At least 19 recordsLinked to original sources
PubMed2006

Synchronous primary cancers of the endometrium and ovary: a case report.

Synchronous primary cancers of the endometrium and ovary are found in 5% of women with endometrial cancer and 10% of women with ovarian cancer. In the present case, a multigravid 46-year-old woman complained of lower abdominal pain and abdominal distension. She did not define abnormal uterine bleeding. Screening ultrasound revealed a papillary containing structure, irregular, cystic 16 x 15 x 10 cm right ovarian mass. Preoperative endometrial biopsy revealed endometrioid adenocarcinoma. Ascites sampling, radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, omentectomy, appendectomy and cytologic sampling of the undersurface of the diaphragm were carried out. Intraoperative and histological examinations showed Stage IIIC papillary serous carcinoma and stage IC endometrioid adenocarcinoma. Synchronous genital tract neoplasms constitute a more common clinical problem than would generally be expected.

Carcinoma, Endometrioid↗
PubMed2005

Value of glutathion-S transferase pi as a prognostic factor in epithelial ovarian carcinoma.

The association between glutathione S-transferase pi (GSTpi) and other clinicopathological parameters, response to chemotherapy and clinical outcome were investigated in chemotherapy naive epithelial ovarian cancer patients. Paraffin-embedded material from 55 patients were used for immunohistochemical analysis. All patients had received six cycles of cisplatinum-based chemotherapy and 41 of them were revalued by laparotomy. Pre- and post-chemotherapy GSTpi staining were detected in the cancer tissues of 18/55 (32.7%) and 5/14 (35.7%) patients, respectively. GSTpi expression was not associated with other clinicopathologic parameters. Of 17 patients with postoperative measurable residual disease clinical response was observed in 4/7 of GSTpi positive and in 9/10 GSTpi negative patients (p = 0.25). Pathologic complete response (pCR) was achieved in 5/8 of GSTpi positive and 11/22 of GSTpi negative cases (p = 0.69). There was no significant difference in overall survival and progression-free survival (PFS) according to initial GSTpi status. However the PFS of the five patients (median 22 +/- 5.9 months) who had postchemotherapy positive GSTpi was significantly shorter than the nine patients (10.0 +/- 2.19 months) who had negative GSTpi (p = 0.006). This difference was not observed in overall survival. These results suggest that initial immunohistochemical staining of GSTpi does not aid in the prediction of pCR and clinical outcome in patients with epithelial ovarian cancer. Nonetheless investigation of GSTpi expression after chemotherapy needs further evaluation.

Adenocarcinoma, Clear Cell↗
PubMed2005

Laparoscopic evaluation of metastatic ovarian cancer: a case report.

UNLABELLED: OBJECTIVE AND CASE: Both noninvasive and invasive methods have limited value in the diagnosis of metastatic ovarian cancer. We present a case with the initial complaint of abdominal distention in whom primary and metastatic tumor sites were safely diagnosed by using laparoscopy: a gastric tumor with ovarian metastasis. DISCUSSION: Diagnostic laparoscopy by the open technique provides a safe and effective diagnostic option in patients with metastatic ovarian cancer.

Adult↗
PubMed2005

Differentiation of benign and malignant adnexal masses: value of a morphologic scoring system.

OBJECTIVE: The purpose of this study was to assess the value of conventional gray-scale ultrasonography, based on a morphologic scoring system, in the differential diagnosis of malignant and benign adnexal tumors. MATERIAL AND METHODS: A total of 58 adnexal masses in 51 patients were classified prospectively as suggestive of malignant or benign, on the basis of gray-scale ultrasonographic morphology. The results were correlated with histopathological diagnosis. RESULTS: Histopathology of 42 masses was found to be benign and 16 masses were found to be malignant. On gray-scale analysis 15 of 16 malignant masses were classified as suggestive of malignant and 37 of 42 benign masses were classified as suggestive of benign. The sensitivity, specificity, positive predictive value and negative predictive value are calculated as 93%, 88%, 75%, and 97%, respectively. CONCLUSION: Prediction of malignancy using gray scale ultrasonograhy based on a morphological scoring system was reliable (NPV = 97%, PPV = 93%). However further investigations about the assessment of adnexal masses with ultrasonography are needed

Adnexal Diseases↗
PubMed2004

Valganciclovir prophylaxis in patients at high risk for the development of cytomegalovirus disease.

BACKGROUND: Despite advances in antiviral therapies, cytomegalovirus (CMV) remains the leading opportunistic infection in the transplant population. Valganciclovir (VGC), the L-valyl ester prodrug of ganciclovir (GCV), provides an excellent oral alternative to GCV for the prevention of CMV in transplant recipients. We investigated the use of VGC for CMV prevention in high-risk renal and pancreas transplant recipients. METHODS: Patients at high risk for development of CMV disease were defined as either those who had donor positive, recipient-negative serostatus (D+/R-), or those who received antilymphocyte antibody (ALA) therapy for either rejection treatment or induction. A retrospective review was conducted of all kidney and pancreas transplants performed between August 2001 and December 2003. A total of 341 transplants were performed, of which 109 received VGC, and 88 were included in this analysis. RESULTS: The overall incidence of CMV disease was 5.7% (5/88). All of the CMV episodes were in patients who were D+/R- (17.2% [5/29] versus 0% [0/59], P<0.001). Of these patients, all the episodes of CMV were in patients who received VGC prophylaxis for<100 days post transplant (29% [5/17] versus 0% [0/12], P=0.06). The overall incidence of leukopenia was 11% and thrombocytopenia was 7%, with the incidence between the D+/R- group and the ALA group being similar. CONCLUSION: VGC is an effective agent in preventing CMV disease in kidney and pancreas transplant recipients who are at high risk for developing the disease. The optimal length of prophylaxis in D+/R- patients is still undefined, while 3 months of prophylaxis appears to be sufficient in patients who received ALA therapy.

Adult↗
PubMed2002

Brain metastasis of ovarian cancer after negative second-look laparotomy.

We present a case of ovarian carcinoma that had brain metastasis seven months after having a negative second-look laparotomy and 13 months after the onset of diagnosis. Despite intense multidisciplinary treatment with surgery, chemotherapy and radiotherapy, the patient died seven months after second-look laparotomy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

In utero intervention in a patient with prune-belly syndrome and severe urethral hypoplasia.

Prenatal ultrasound scanning of a 20-year-old woman at 17 weeks of gestation revealed findings suggestive of bladder outlet obstruction, including bladder distension, dilated bilateral ureters, urinary ascites, and oligohydramnios. Vesicoamniotic shunts were placed with decompression of the bladder and correction of the amniotic fluid levels. Labor was induced at 36 weeks' gestation. At birth, the infant was noted to have prune-belly syndrome with severe urethral hypoplasia, a variant usually associated with a poor prognosis, necessitating vesicostomy for bladder drainage. We present a case of a patient with prune-belly syndrome and bladder outlet obstruction in whom early intervention resulted in an excellent outcome with preservation of renal and pulmonary function.

Adult↗
PubMed2001

The efficacy of combination chemotherapy including intraperitoneal cisplatinum and mitoxantrone with intravenous ifosfamide in patients with FIGO stage I C ovarian carcinoma.

OBJECTIVE: Patients with stage I ovarian cancer show a high incidence of recurrent disease ranging from 30% to 50%, which may be associated with a shortened survival. Therefore, a subset of early-stage patients with poor prognostic factors who are most likely to present with recurrent disease in the next few years may benefit from adjuvant treatment. PATIENTS AND METHOD: In this pilot study, we evaluated the efficacy of combination chemotherapy including intraperitoneal mitoxantrone (12 mg/ml) and cisplatinum (75 mg/ml) on day 1, in addition to intravenous ifosfamide (4000 mg/m2) given on day 15 with mesna protection. Thirteen patients with a median age of 44 years were included in the study. RESULTS: Following a median of 5 cycles of chemotherapy, 12 patients had a complete response (92.3%), while one patient had progressive disease. At the latest follow-up, ten patients were alive with no evidence of disease, two patients had died and one patient was lost to follow-up. Overall and progression-free survival rates at eight years were 82.5+/-11.3% and 83.9+/-10.5%, respectively. Excluding grade 3 and 4 abdominal pain in three (23.1%) patients, there were no serious complications associated with this combination. Dose delay not longer than one week was observed in 3 cycles (5.6%). Port-related complications observed in three patients were colonic perforation, hematoma and leakage. CONCLUSION: This combination has moderate efficacy and tolerable toxicity. However, further studies are required to make definite conclusions regarding the efficacy of this combination in the adjuvant setting in patients with high-risk early stage ovarian carcinoma.

Adenocarcinoma, Clear Cell↗
PubMed2001

Nongenital metastatic cancers of the ovary: a clinical analysis.

OBJECTIVES: The aim of this study was to outline the parameters affecting the extent and type of surgery for metastatic tumors of the ovary. MATERIAL-METHOD: The data of 34 operated patients diagnosed with metastatic tumors of the ovary at the Istanbul University, Medical Faculty Gynecologic Oncology Department between 1991 and 1999 were evaluated retrospectively. The patients were divided into two study groups according to the origin of the tumor: 1. Metastatic tumors of the ovary originating from the organs apart from the gastrointestinal system (MT-NonGIS). 2. Metastatic tumors of the ovary originating from the gastrointestinal system (MT-GIS). Survival rates were calculated in months from the time of ovarian surgical intervention to the date of last known data of patient status. Mean survival rates for the noncensored data were calculated by the Kaplan-Meier method and resulting curves were compared by the log-rank procedure. Statistical significance was determined at the level of 0.05. RESULTS: The survival rate for all cases was 24.21 months: the same rate was calculated to be 45.36 months for the MT-nonGIS group while it was 15.8 months for the MT-GIS group. When both groups were compared in terms of survival rates, the difference was significant (p: 0.0025, log rank: 9.14). Overall cumulative survival rates for 9, 14, 24 and 50 months were 61.59%, 50.05%. 41.7% and 11.58%, respectively. It was also found that surgery performed on patients in the MT-GIS group did not alter the survival rate but if peritoneal metastasis was observed during surgery, life expectancy for these cases was significantly less. CONCLUSION: Although the number of patients included in our study was small, it is important because it gives us a clue about the type of surgery that should be performed in GIS-originating metastatic tumors of the ovary. Our study shows that aggressive surgery should be avoided in patients with peritoneal metastasis/spread.

Adult↗
PubMed2000

Celsite port and catheter as an intraperitoneal access device in the treatment of ovarian cancer.

BACKGROUND AND OBJECTIVES: In ovarian cancer, development of safe and effective methods for providing long-term access to the peritoneal cavity has become increasingly important. METHODS: A modified Port-A-Cath (Celsite-port and catheters, B. Braun, Chasseneuil, France) was used in 56 patients with presumed epithelial ovarian cancer at the conclusion of primary or second-look laparotomy. In 37 patients, ports were located on the right costal margin in the midclavicular region and in 19 in the xiphoid region. RESULTS: In 56 catheters, 8 (13.8%) complications of severe or moderate degree during the treatment were registered. In-flow obstruction of device occurred in 6 patients, and there was 1 viscous perforation and 1 catheter related infectious peritonitis. Grade III-IV pain and in-flow obstruction were developed in the patients with ports implanted on the right costal margin but not with ports implanted in the xiphoid region. CONCLUSION: The complication rate of intraperitoneal access devices is comparatively low.

Adult↗
PubMed1999

A patient-centered approach to advance medical planning in the nursing home.

OBJECTIVE: The objective of this study is to determine whether nursing home residents or their surrogates are willing and able to prioritize their goals for care and to demonstrate how these rankings can form the basis of a specific pattern of medical care. DESIGN: A prospective, descriptive study. SETTING: A 40-bed nursing unit for residents with mild to moderate impairments in a 725-bed teaching nursing home. RESULTS: Overall, 78% of patients or their families were willing to prioritize their goals, allowing the investigators to infer a pattern of care. The goals were interpreted as implying an intensive pattern in 21%, a comprehensive pattern in 16%, a basic pattern in 18%, palliation in 18%, and comfort only in 6% of residents. Goals chosen by residents who were able to select for themselves translated into more aggressive care than did the goals selected by surrogates. CONCLUSION: Goal-centered advance medical planning can be initiated in nursing homes by asking residents or their surrogates to prioritize their goals of care. These prioritizations can form the foundation for specific patterns of care.

Advance Care Planning↗
PubMed1998

Intraperitoneal cisplatin-mitoxantrone and intravenous ifosfamide combination as first-line treatment of ovarian cancer.

Twenty-one chemotherapy naive ovarian cancer patients with stage III and minimal residual tumor were treated with cisplatin 75 mg/m2 and mitoxantrone 15 mg/m2 (1st day) by intraperitoneal (i.p.) route and ifosfamide 4 g/m2 (15th day) by i.v. route every 4 weeks for a total of 6 cycles. Pathologic complete response (pCR) was achieved in 9/20 (45%, 95% Confidence Interval - CI - 23-68) of the patients. The median progression free interval (PFI) of the patients with pCR was 45 (range: 18-70) months. For patients with residual tumor <1 cm (n: 11); pCR was 82% and could be achieved only in this subgroup of patients. The cumulative (PFI) and overall survival rate of all patients at 3 years were 40% and 52%, respectively. The median PFI was found to be significantly different between the patients with residual tumor <1 cm (48 months, 95% CI 42-54) and 1-2 cm (9 months, 95% CI 1-16) p<0.001. Main toxicities were emesis and abdominal pain which occurred in 53% and 65% of the courses, respectively. This combination seems to be an effective and feasible approach to previously untreated ovarian cancer patients with minimal tumor burden.

Adult↗
PubMed1998

Long-term adjustment issues in patients with exstrophy.

PURPOSE: We explored the psychological adjustment of children with bladder or cloacal exstrophy. MATERIALS AND METHODS: We assessed 29 subjects with a mean age plus or minus standard deviation of 7.8 +/- 3.97 years using age appropriate standard psychological instruments. Psychological adjustment scores in the exstrophy group were compared to the norms of the various instruments. Subjects were divided into dichotomous groups according to several medical and demographic factors. For each factor the differences between the means of the 2 groups on the outcome variables were calculated using a t test. RESULTS: Children with exstrophy perceived their appearance more positively than the norm. Older children performed more poorly than younger children in adaptive behavior, specifically in skills related to functioning in school. Children who achieved continence after age 4 years were more likely to have problems with acting out behavior. There were no differences in adjustment in boys versus girls, bladder versus cloacal exstrophy, type of continence strategy or gender reassignment versus no reassignment. CONCLUSIONS: Children with exstrophy did not have clinical psychopathology. Differences existed in adaptive and acting out behavior rather than depression or anxiety, suggesting that improved outcomes may be achieved through a focus on normal adaptation rather than on potential psychological distress.

Adaptation, Psychological↗
PubMed1997

Intraperitoneal cisplatin--mitoxantrone in ovarian cancer patients with minimal residual disease.

A phase II trial was conducted to further explore the potential of salvage intraperitoneal (IP) cisplatin-based therapy in patients with residual ovarian cancer. Twenty-five patients were treated with a regimen of cisplatin (75 mg/m2) and mitoxantrone (15 mg/m2) delivered IP every three weeks for a maximum of six cycles. Ten patients achieved a pathologically complete response (pCR) and six were clinically stable without evidence of disease. After a median follow-up of 18 months, the median progression-free survival (PFS) was 16 months (95% confidence interval-CI-3-29%). The actuarial PFS at 24 months was 36% (95% CI 13-59). Overall eight out of 25 patients (32%) had an IP relapse and thus were considered as local treatment failures. The major toxic side effects were nausea, vomiting, abdominal pain and renal toxicity. Future trials exploring IP delivery of these drugs should attempt to optimize drug dose and schedule and subset analysis of clinical studies should help in identifying patients who are particularly sensitive to this therapeutic approach.

Adult↗
PubMed1997

Has there been a recent shift in the pathological features and prognosis of patients treated with radical prostatectomy?

PURPOSE: We determined if there has been a significant change in pathological stage or prognosis of patients with clinically localized prostate cancer treated with radical prostatectomy between 1983 and 1995. During this period the methods of detection of prostate cancer changed to include, in recent years, a large proportion of nonpalpable cancers detected by prostate specific antigen (PSA). MATERIALS AND METHODS: The method of diagnosis, pathological features and prognosis (PSA detected progression-free probability) of 754 consecutive patients treated by 1 surgeon for clinical stages T1 to 3NXMO prostate cancer from 1983 to 1995 were analyzed by year of diagnosis. RESULTS: There was a marked increase in the annual number of radical prostatectomies performed with time. The proportion of cancers initially detected by transurethral resection decreased markedly after 1989. Beginning in 1990 nonpalpable cancers detected by PSA increased substantially to 52% by 1995. However, there was no significant change in preoperative serum PSA, tumor volume or pathological stage during the study period. The proportion of patients with well differentiated cancer decreased somewhat, while those with moderate to poorly differentiated (Gleason sum 7) cancers increased significantly after 1991. There was no increase with time in the proportion of patients with a small (less than 0.5 cm.3), well or moderately differentiated (Gleason grades 1 to 3) cancer confined to the prostate (an indolent or clinically unimportant cancer) but fewer patients in recent years had an advanced cancer (established extraprostatic extension with a positive surgical margin, seminal vesicle invasion or lymph node metastases). The actuarial probability of progression after surgery was similar for patients treated from 1983 to 1987, 1988 to 1991 and 1992 to 1995. CONCLUSIONS: Despite marked changes in the number of patients treated each year and the method by which cancers were first detected, we found no change in pathological stage or prognosis (progression rate) for patients treated with radical prostatectomy between 1983 and 1995. Despite concerns that the increased detection of prostate cancer could lead to many more patients being treated unnecessarily for small, indolent cancers, we found no increase in the proportion of such cancers with time.

Actuarial Analysis↗
PubMed1996

Evolutionary conservation of sequence and expression of the bHLH protein Atonal suggests a conserved role in neurogenesis.

atonal is a Drosophila proneural gene that belongs to the family of basic helix-loop-helix (bHLH)- containing proteins. It is expressed in the chordotonal organs and photoreceptor cells, and flies that lack Atonal protein are ataxic and blind. Here we report the cloning of atonal homologs from red flour beetle, puffer fish, chicken, mouse, and human. The bHLH domain is conserved throughout evolution, while the entire coding region is highly similar in mammals. Both the chicken and the mouse homologs are expressed early in embryogenesis in the hind brain, and specifically in cells predicted to give rise to the external granular layer of the cerebellum. In addition, these genes are expressed throughout the dorsal part of the spinal cord, in patterns different from those found for other genes, like LH-2 and wnt-1. The mouse homolog (Math1) maps to mouse chromosome 6, and the human homolog (HATH1) to human chromosome 4q22. Two neurological mouse mutants, Lc and chp, were found to map to the vicinity of Math1, but are not caused by mutations in Math1. The evolutionary conservation of this gene and its mRNA expression patterns during embryogenesis suggests that it plays a key role in the development of the vertebrate central nervous system.

Amino Acid Sequence↗