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Biomedical subjects

T V Sedlacek

Publications and source records attributed to T V Sedlacek.

At least 19 recordsLinked to original sources
PubMed1996

Applications of the monitoring process model to coping with severe long-term medical threats.

Guided by the monitoring process model (MPM), the authors explored the illness responses of 2 samples: high monitors (who are cognitively vigilant to and amplify threat-related cues) and low monitors (who avoid them and blunt their impact). Both samples-101 women with human papillomavirus-related precancerous cervical dysplasia and 75 HIV-infected gay men-were undergoing long-term medical follow-up and management. Structural equation analysis showed an adequate fit of the MPM to the data within each sample, supporting the model's heuristic value: High monitors experienced greater disease-related intrusive ideation, which triggered greater avoidant ideation to forestall panic, particularly in the more threatened HIV-positive sample. However, efforts to avoid disturbing intrusive thoughts were ineffective, requiring increasingly extreme defensive strategies (i.e., denial and mental and behavioral disengagement).

Adaptation, Psychological↗
PubMed1993

Colposcopy in pregnancy.

The management of the abnormal smear in pregnancy remains a challenge to the modern colposcopist. Colposcopy in pregnancy is difficult. Anatomic variants can mimic disease. Significant cytologic overall detection of low-grade squamous intraepithelial lesions demands an increased understanding of physiologic variants in pregnancy. Possible recent increases in cervical cancer incidence in younger women requires comprehensive knowledge of warning signs of early invasion. Modern management approaches must temper the need for accurate exclusion of cancer with the risk of overly aggressive interference in patients without disease or with very minor atypia.

Biopsy↗
PubMed1992

Mullerian adenosarcoma of the uterus with sarcomatous overgrowth.

A case of mullerian adenosarcoma of the uterus with sarcomatous overgrowth is described. The patient was also found to have bilateral polycystic ovaries. This 25 year-old white female presented with irregular vaginal bleeding and was diagnosed as having mullerian adenosarcoma with sarcomatous overgrowth by dilatation, curettage, and biopsy. Total abdominal hysterectomy, bilateral salpingo-oophorectomy with lymph node sampling were performed.

Adult↗
PubMed1992

Para-aortic node sampling in small (3-cm or less) stage IB invasive cervical cancer.

Only 2 of 125 patients with FIGO stage IB invasive squamous or adenocarcinoma of the cervix 3 cm or less in diameter who underwent exploration for radical hysterectomy, bilateral pelvic lymphadenectomy, and para-aortic node sampling had metastases to the para-aortic nodes. No patient had gross para-aortic nodal involvement, and both patients with microscopic para-aortic nodal metastases had grossly positive pelvic nodal involvement. Para-aortic node sampling in patients with small stage IB cervical cancers undergoing radical hysterectomy may be restricted to patients with suspicious pelvic or para-aortic nodes.

Adenocarcinoma↗
PubMed1992

Congenital pelvic arteriovenous malformations: long-term follow-up in two cases and a review of the literature.

Congenital arteriovenous malformations confined to the soft tissues of the pelvis are rare and challenging lesions. Multitudinous embryonic macrocommunication and microcommunication between the arterial and venous systems, with resultant shunting of blood to the low-resistance veins, produce massive venous and tissue engorgement. No well-established guidelines exist concerning their management. Percutaneous arterial embolization and surgery are associated with high recurrence rates. Surgical excision is frequently not possible and can result in massive hemorrhage. Only 52 cases have been reported in the English-language literature, and only two patients were followed for longer than 6 years. This report presents two additional patients with massive pelvic arteriovenous malformations monitored for 9 and 17 years. One patient was initially treated with arterial percutaneous embolization and the other with attempted operative ablation. A review of the literature has allowed us to develop the following management guidelines: Asymptomatic, nonenlarging lesions require no intervention and can be safely followed by clinical and radiologic (ultrasonography, CT scanning) examinations every 6 months. Symptomatic or rapidly enlarging lesions should be treated with preoperative arterial embolization and surgical excision attempted only if the arteriovenous malformation is localized and does not involve adjacent organs. Arterial embolizations may be repeated to provide symptomatic relief of diffuse, large lesions that involve the bladder or bowel. This protocol will avoid unnecessary and frequently life-threatening surgery in the management of pelvic arteriovenous malformations.

Adult↗
PubMed1991

The clinical role of human papilloma virus typing.

Patients with abnormal Pap smears underwent repeat Pap smear, colposcopy, biopsy, and human papilloma virus (HPV) typing to identify the presence of CIN and to assess the correlation of HPV type to grade of CIN and behavior of CIN. A total of 334 patients underwent evaluation and typing with Southern blot methodology. Fifty-five percent (185) of the patients demonstrated HPV viral sequences; 98 of the 185 positive patients demonstrated HPV types 16, 18. The presence of HPV sequences was not associated with a higher frequency of positive cytology of CIN II or III. High-grade CIN (II or III) was seen in 17.3, 13.5, 13.8, and 10.7% of patients with HPV 16, 18; 6, 11; 31, 33, 35; or no HPV sequences. Of 52 patients with normal cytology and biopsy revealing less than or equal to CIN I, no patients with types 6, 11, 3/5 patients with 31, 33, 35, 3/15 patients with 16, 18, and 2/23 patients with no HPV sequences progressed to greater than or equal to CIN II. These data do not support a role for HPV typing in predicting the initial histology. Typing may be of some value in monitoring patients with low-grade lesions.

Biopsy↗
PubMed1991

Cervical malignancies.

Articles published between August 1989 and July 1990 related to squamous cell carcinoma of the cervix are reviewed. A discussion of new histopathologic findings is given along with current hormonal receptor studies. The host immunocompetence with an immunologic staging system is presented. Recent studies of the clinical application of the serum squamous cell antigen are reviewed. The finding of positive pelvic nodes at the time of a radical hysterectomy is investigated within literature review. The advantages and risks of radical surgery, radiation therapy, and combined treatments are presented with no clear conclusion being found. Advanced or recurrent cervical cancers may be treated with radiation, chemotherapy, or ultraradical surgery depending on the clinical setting. Early studies of combination therapies are given for these difficult situations.

Antigens, Neoplasm↗
PubMed1990

Vaginal and vulvar adenosis. An unsuspected side effect of CO2 laser vaporization.

During a 15-month period, September 1984 through January 1986, 10 women who were treated in the Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania, developed vaginal or vulvar adenosis after CO2 laser vaporization. The indications for therapy were condylomata of the cervix, vagina and vulva refractory to conservative management in 3 patients, vulvar intraepithelial neoplasia in 3, lichen sclerosus in 1 and cervical intraepithelial neoplasia with condylomata on the cervix and vagina in 3. All the patients underwent treatment of the vagina. Most underwent treatment of the cervix, and some underwent treatment of the vulva at various degrees of intensity and depth. During the posttreatment colposcopic follow-up examination, all the patients demonstrated lesions colposcopically consistent with adenosis of the vagina or vulva within the area treated with the CO2 laser. Biopsies of the lesions were performed, adenosis was confirmed histologically, and endometriosis was ruled out histologically. This entity has not been previously associated with CO2 laser vaporization, and its clinical significance is undetermined. Further follow-up is indicated.

Adult↗
PubMed1990

Studies on the transmission of viral disease via the CO2 laser plume and ejecta.

While recent reports have noted the presence of viral DNA sequences in the laser plume, no significant effort has been made to study transmission of the virus in vivo via airborne laser debris. Studies were undertaken to identify potential hazards to operating room occupants in gynecologic laser surgery. ACO2 laser in the continuous wave mode using a power density of 666 W/cm2 was fired through a 5-cm metal cylinder at virus-infected tissues. Airborne particulate debris, 100-200 microns, was removed from the cylinder's inner surfaces. In one instance, deposition of the debris was found on the surgeon's eyeglasses 1 m from the site of impact despite the use of a smoke evacuator. The first set of studies involved confirmed human papillomavirus (HPV) lesions of the human female lower genital tract. Specimens were collected for electron microscopy and Southern Blot viral hybridization. Additional cervical electron microscopy specimens were recovered from the speculum during pulsed CO2 laser treatment at 13 W average power during conization. Electron microscopy of the vulvar debris revealed only anucleate keratinized squamous epithelial cells. Cervical specimens demonstrated similar cells with nearly instantaneous vaporization of intracellular water and apparent condensation of cellular carbon. HPV Southern Blot testing revealed insufficient quantities of DNA for that technique. The second set of studies involved bovine papillomavirus lesions from dairy cattle. The debris was transmitted to susceptible animals. The bovine studies failed to demonstrate the transmission of disease in vivo.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Increased frequency of detection of human papillomavirus deoxyribonucleic acid in exfoliated cervical cells during pregnancy.

Exfoliated cells of the uterine cervix obtained from women during pregnancy and at the time of their first postpartum examination were used to monitor the prevalence of human papillomavirus infections in this population and to study the natural fluctuations in viral expression. When deoxyribonucleic acid hybridization analysis alone was used to monitor the presence of human papillomavirus infection, 20.9% of our study population had results that were positive for human papillomavirus deoxyribonucleic acid during their first-trimester examinations. A dramatic increase in the percentage of women with positive results for human papillomavirus deoxyribonucleic acid was observed at the time of the patients' third-trimester examinations (46%). The overall increase in human papillomavirus-positive patients was a combination of a small number of patients who had positive results on their first examination and negative results on their second examination, and a larger number of patients who had negative results on their first-trimester examination and positive results for human papillomavirus deoxyribonucleic acid in the exfoliated cervical cells at the time of their third-trimester examination. The total percentage of patients with positive results for human papillomavirus deoxyribonucleic acid in their cervical cells at one or both assay points during pregnancy was 52.5%. Samples obtained at the postpartum examination demonstrated a dramatic decrease in the number of samples positive for human papillomavirus deoxyribonucleic acid (17.5%). This result was a combination of a large decrease in human papillomavirus-positive patients coupled with a small increase in detectable levels of human papillomavirus deoxyribonucleic acid in cervical samples from patients who had negative results on their previous examination. This study demonstrates a very high level of detectable human papillomavirus deoxyribonucleic acid in exfoliated cervical cells obtained during pregnancy and shows that the detectable levels of human papillomavirus deoxyribonucleic acid fluctuate during pregnancy.

Cervix Uteri↗
PubMed1989

Mechanism for human papillomavirus transmission at birth.

We attempted to investigate mechanisms, in addition to sexual contact, by which human papillomaviruses associated with anogenital tract lesions could be transmitted. Samples of exfoliated cervical cells were obtained from 45 pregnant women and were assayed by Southern blot hybridization analysis for the presence of human papillomavirus nucleic acids. Twenty-five of the 45 women had cells positive for human papillomavirus deoxyribonucleic acid. A neonatal nasopharyngeal aspirate was obtained at term and analyzed for the presence of human papillomavirus deoxyribonucleic acid. We documented the presence of human papillomavirus deoxyribonucleic acid in the oral pharyngeal cavity of the neonates in 15 of 45 nasopharyngeal samples analyzed. Amniotic fluid was obtained from 13 patients when their membranes were artificially ruptured. These samples were assayed for the presence of human papillomavirus deoxyribonucleic acid; two of the 13 amniotic fluid samples contained human papillomavirus deoxyribonucleic acid. The detection of human papillomavirus deoxyribonucleic acid in the oral cavity of neonates is indicative of a perinatal mechanism of viral transmission. The detection of human papillomavirus deoxyribonucleic acid in the amniotic fluid may suggest an in utero mechanism of transmission. However, problems encountered in collecting the amniotic fluid samples preclude us from definitive interpretation of these data.

Adult↗
PubMed1989

Extended carbon dioxide laser vaporization in the treatment of subclinical papillomavirus infection of the lower genital tract.

This study examined the use of extended carbon dioxide laser vaporization in 25 women with histologically confirmed, multicentric subclinical papillomavirus infection of the lower genital tract to determine whether carbon dioxide laser can eradicate subclinical papillomavirus infection. An extended carbon dioxide laser procedure involved vaporization of the epithelium of the entire lower genital tract. We performed the procedure under colposcopic guidance. Vaporization was carried out in continuity, to an appropriate tissue depth, while using recommended power densities for the respective target tissue. For sexually active study patients, male consorts were evaluated and treated concurrently to reduce the risk of recurrent infection. Postoperative morbidity was considerable, with moderate to severe vulvar pain and febrile reactions occurring in 100 and 76% of patients, respectively. Histologic persistence of subclinical papillomavirus infection was documented in 88% of study patients at follow-up examination. Neither treatment of the male consort nor sexual abstinence significantly improved treatment outcome. These data suggest that extended carbon dioxide laser procedures cause significant short-term morbidity without effectively eradicating subclinical papillomavirus infection of the female lower genital tract.

Adolescent↗
PubMed1988

Results of carbon dioxide laser therapy and topical 5-fluorouracil treatment for subclinical condyloma found by magnified penile surface scanning.

Previously we demonstrated a 68 per cent recurrence rate for subclinical penile human papillomavirus infections found by magnified penile surface scanning and treated with the carbon dioxide laser. In this report it is shown that the addition of a regimen of adjuvant topical 5-fluorouracil does not lower the recurrence rate. This knowledge combined with the evidence for a subclinical urethral reservoir of human papillomavirus implies that any strictly topical therapy will fail at 4 months of followup and that improved systemic therapy may be needed.

Administration, Topical↗
PubMed1987

The influence of hematogenous and serosal metastases on advanced (FIGO IIA-IVB) squamous cell carcinoma of the cervix.

Of 120 patients with FIGO stage IIA-IVB squamous cell carcinoma of the cervix treated with standard radiotherapeutic techniques, 41 (34.2%) relapsed with hematogenous or serosal metastases. Development of such metastases was individually associated with patient age less than or equal to 55, bilateral bulky parametrial extension, and histologically positive paraaortic nodes. Poor histologic differentiation exerted significant negative influence only in patients age less than or equal to 55. Neither surgical staging nor vascular injury predisposed to hematogenous dissemination. Radiotherapy techniques differed only in increased time to completion, from 84 to 100 days in clinical IIB and IIIB patients developing metastases. Local or regional pelvic recurrences, although associated with an increase in hematogenous or serosal metastases, were not accompanied by concomitant relapse in extrapelvic nodes. Twenty-six of 41 metastases were limited to single organ systems, with pulmonary sites most common (43.9%). A direct (non-nodal) route of hematogenous dissemination of 31% was documented within clinical stages IIA and IIB. One hundred percent concordance between bilateral bulky parametrial involvement and positive pretreatment paraaortic nodes occurred in clinical stage IIIB and IVA patients with metastatic relapse. Our data from the period 1976-1985 do not substantially differ from earlier reports on the incidence or distribution of hematogenous or serosal metastases, despite our implementation of contemporary local/regional radiotherapy prescriptions. The potential for hematogenous and serosal metastases in high-risk patients with advanced squamous cervical carcinoma merits consideration of alternative treatment protocols and precise definition of the role of pretreatment surgical staging procedures.

Adult↗
PubMed1986

Colposcopy in the diagnosis of penile condyloma.

To determine the incidence of penile condyloma in a group of high-risk men, we carried out colposcopy and biopsy of suspicious lesions in 51 men. All men were partners of women with condyloma. Of these men, 45 were found to have histologic evidence of condyloma, and only eight of these had grossly visible disease.

Adult↗
PubMed1986

Magnified penile surface scanning in diagnosis of penile condyloma.

To determine the incidence of penile condyloma in a group of high risk males, we have performed magnified penile surface scanning and biopsy of suspicious lesions in 51 men. All men were partners of women with proven condyloma. Of these men, 45 were found to have histologic evidence of condyloma, only 8 of which were grossly visible.

Adult↗