Biomedical subjects

W A Peters

Publications and source records attributed to W A Peters.

At least 19 recordsLinked to original sources

PubMed2001

Rectal prolapse in women with other defects of pelvic floor support.

OBJECTIVES: We describe a series of patients with rectal prolapse who had other pelvic floor defects. STUDY DESIGN: Patients with rectal prolapse that we examined between 1990 and 2000 were reviewed. RESULTS: During this time frame 55 patients with rectal prolapse were seen by one of us. Fifty-two of these patients had other defects of pelvic floor support and are the subject of this report. The diagnosis was established in all patients with video defecography. Thirty-nine of the patients had internal (occult) prolapse that simulated either a rectocele or an enterocele. The mean number of surgical procedures for pelvic floor support before the diagnosis of rectal prolapse was 1.5. Thirty-one patients underwent a sigmoid resection with rectopexy, 12 underwent a rectopexy alone, 3 underwent a Ripstein procedure, 2 elderly patients had physical therapy alone, and the other 4 patients had surgical correction of the rectal prolapse before being referred for repair of vaginal vault prolapse. Other procedures performed simultaneously included sacral colpopexy, sacrospinous suspension, rectopubic urethropexy, and abdominal fixation of the vagina to the uterosacral ligaments. CONCLUSIONS: Rectal prolapse frequently coexists with other pelvic floor defects. Internal rectal prolapse may simulate a rectocele or enterocele and requires defecography to establish the diagnosis. Rectopexy (with or without sigmoid resection) is a satisfactory technique for correction and may be combined with other reconstructive procedures on the pelvic floor.

Adult↗

PubMed2000

Thermodynamic driving forces for PAH isomerization and growth during thermal treatment of polluted soils.

For a limiting case of thermodynamic equilibrium, the importance of two classes of thermal chemical reactions that modify the structure and bioactivity of polycyclic aromatic hydrocarbons (PAH) was assessed computationally. These reactions are molecular weight (MW) growth by acetylene addition, and intramolecular rearrangement (isomerization). Temperatures (300-1100 degrees C), and the chemical environment (C(2)H(2)/H(2) molar ratios) were selected for relevancy to thermal treatment of PAH-contaminated soils under oxygen-free conditions. Molecular mechanics methods [MM3(92)] were used to compute thermochemical properties for calculation of equilibrium constants, i.e., heats of formation, standard entropies, and heat capacities for 30 PAH with empirical formulae C(14)H(10), C(16)H(10), C(18)H(10), C(18)H(12), C(20)H(10), and C(20)H(12). Included were 11 PAH containing only six-membered rings and 19 PAH containing both five- and six-membered rings. For each of these PAH the calculations predict that with increasing temperature, isomerization increases the "complexity" of the PAH mixture, i.e., the relative abundance of each PAH isomer in the mixture other than the most stable isomer, increases. Isomerization also partially transforms non-mutagens to mutagens, e.g., pyrene and benzo[e]pyrene to fluoranthene and benzo[a]pyrene, respectively, and partially converts cyclopenta[c, d]pyrene (CPEP) and chrysene, both human cell mutagens, to one and three additional human cell mutagens, respectively. Acetylene addition transforms the non-mutagens phenanthrene and pyrene to the mutagens triphenylene and CPEP, respectively. Some of the predicted PAH have been observed elsewhere among the products of aromatics pyrolysis. This study elucidates PAH reactivity for comparison with measurements, and identifies PAH reactions to be monitored and avoided in soil thermal decontamination and other waste remediation processes.

Models, Theoretical↗

PubMed2000

A phase I trial of a 3-day topotecan Q 21 days for recurrent epithelial cancers of the ovary, fallopian tube, and peritoneum.

OBJECTIVE: This trial was undertaken to determine the dose limiting toxicity (DLT) and maximum tolerated dose (MTD) of topotecan that can be administered for 3 days q 21 days. A 3-day schedule is more convenient and less expensive than standard 5-day dosing. METHODS: Patients with recurrent epithelial ovary, tubal, or peritoneal carcinoma were treated with escalating doses of topotecan beginning at 2.50 mg/m(2) as an outpatient days 1-3 q 21 days. Colony stimulating factors were not employed prophylactically, but could be added for grade 4 marrow toxicity. RESULTS: Twenty patients with a median age of 61 (range 46-80) and performance status of 0 or 1 were entered. All patients had received at least one prior paclitaxel/platinum regimen; 6 had received two. Ninety-one cycles were delivered (median = 6) and 98.9% were on schedule. Grade 4 neutropenia was seen in 17 of 20 patients (85%) in cycle 1 and in 38 of 91 (41.8%) total cycles. Sixteen of 20 patients (80%) started G-CSF on cycle 2. Two of 91 (2.2%) cycles had grade 4 thrombocytopenia. Four cycles (4.4%) were associated with febrile neutropenia. Two patients experienced grade 4 neurotoxicity (DLT) at 4.25 mg/m(2). Other nonhematologic toxicity was mild. CONCLUSIONS: Topotecan can be safely administered on schedule as an outpatient days 1-3 q 21 days. Neurotoxicity was the DLT when G-CSF was added; the MTD was 3.75 mg/m(2). There was minimal other nonhematologic toxicity. Neutropenia was predictable and easily managed with G-CSF. Febrile neutropenia was uncommon and thrombocytopenia was rare at the doses evaluated.

Aged↗

PubMed2000

Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix.

PURPOSE: To determine whether the addition of cisplatin-based chemotherapy (CT) to pelvic radiation therapy (RT) will improve the survival of early-stage, high-risk patients with cervical carcinoma. PATIENTS AND METHODS: Patients with clinical stage IA(2), IB, and IIA carcinoma of the cervix, initially treated with radical hysterectomy and pelvic lymphadenectomy, and who had positive pelvic lymph nodes and/or positive margins and/or microscopic involvement of the parametrium were eligible for this study. Patients were randomized to receive RT or RT + CT. Patients in each group received 49.3 GY RT in 29 fractions to a standard pelvic field. Chemotherapy consisted of bolus cisplatin 70 mg/m(2) and a 96-hour infusion of fluorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles, with the first and second cycles given concurrent to RT. RESULTS: Between 1991 and 1996, 268 patients were entered onto the study. Two hundred forty-three patients were assessable (127 RT + CT patients and 116 RT patients). Progression-free and overall survival are significantly improved in the patients receiving CT. The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 (P =.003) and 1.96 (P =. 007), respectively. The projected progression-free survivals at 4 years is 63% with RT and 80% with RT + CT. The projected overall survival rate at 4 years is 71% with RT and 81% with RT + CT. Grades 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group. CONCLUSION: The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk, early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix.

Adult↗

PubMed2000

Chemical characterization and bioactivity of polycyclic aromatic hydrocarbons from non-oxidative thermal treatment of pyrene-contaminated soil at 250-1,000 degrees C.

In this paper we report yields, identities, and mutagenicities of products from heating a polycyclic aromatic hydrocarbon (PAH)-contaminated, Superfund-related synthetic soil matrix without exogenous oxygen. We heated batch samples of soil pretreated with 5.08 wt% (by weight) pyrene in a tubular furnace under a constant flow of helium gas at 250, 500, 750, and 1,000 +/- 20 degrees C. Dichloromethane (DCM) extracts of cooled residues of heated soil and of volatiles condensed on a cold finger after 1 sec residence time at furnace temperature were assayed gravimetrically and analyzed for PAH by HPLC, HPLC coupled to mass spectrometry, and gas chromatography coupled to mass spectrometry. All four temperatures volatilized pyrene and generated other PAHs, including alkylated pyrenes. We detected bioactive PAHs in the product volatiles: cyclopenta[cd]pyrene (CPP) at 750 and 1,000 degrees C and benzo[a]pyrene (BaP) at 1,000 degrees C. We found a clean soil residue, i.e., no pyrene or other DCM extracts, only at 750 degrees C. Control experiments with uncontaminated soil, pyrene, and Ottawa sand plus 4.89 wt% pyrene revealed no CPP or BaP production from soil itself, but these experiments imply that pyrene interactions with soil, e.g., soil-bound silica, stimulate CPP and BaP production. We detected mutagenicity to human diploid lymphoblasts (in vitro) in volatiles from 1,000 degrees C heating of soil plus pyrene and sand plus pyrene, and in the residue from 500 degrees C heating of soil plus pyrene. Three plausible pathways for pyrene conversion to other PAHs are a) a reaction with light gas species, e.g., soil- or pyrene-derived acetylene; b) loss of C(2)-units followed by reaction with a PAH; and c) dimerization with further molecular weight growth via cyclodehydrogenation. This study shows that thermal treatment of PAH-polluted soil may generate toxic by-products that require further cleanup by oxidation or other measures.

Benzopyrenes↗

PubMed1999

Thermogravimetric study of thermal decontamination of soils polluted by hexachlorobenzene, 4-chlorobiphenyl, naphthalene, or n-decane.

To determine decontamination behavior as affected by temperature, shallow beds of a clay-rich, a calcerous, and a sedimentary soil, artificially polluted with hexachlorobenzene, 4-chlorobiphenyl, naphthalene, or n-decane, were separately heated at 5 degrees C min-1 in a thermogravimetric analyzer. Temperatures for deep cleaning of the calcerous and the sedimentary soil increased with increasing boiling point (bp) of the aromatic contaminants, but removal efficiencies still approached 100% well below the bp. Decontamination rates were therefore modelled according to a pollutant evaporation-diffusion transport model. For the calcerous and sedimentary soils, this model reasonably correlated removal of roughly the first 2/3 of the naphthalene, but gave only fair predictions for hexachlorobenzene and 4-chlorobiphenyl. It was necessary to heat the clay soil above the aromatics bp to achieve high decontamination efficiencies. Weight loss data imply that for temperatures from near ambient to as much as 150 degrees C, interactions of each aromatic with the clay soil, or its decomposition products, result in lower net volatilization of the contaminated vs. neat clay. A similar effect was observed in heating calcerous soil polluted with hexachlorobenzene from near ambient to about 140 degrees C. Decontamination mechanisms remain to be established, although the higher temperatures needed to remove aromatics from the clay may reflect a more prominent role for surface desorption than evaporation. This would be consistent with our estimates that the clay can accommodate all of the initial pollutant loadings within a single surface monolayer, whereas the calcerous and sedimentary soils cannot.

Alkanes↗

PubMed1999

Frequent loss of heterozygosity for chromosome 10 in uterine leiomyosarcoma in contrast to leiomyoma.

Distinction of malignant uterine leiomyosarcomas from benign leiomyomas by morphological criteria is not always possible. Leiomyosarcomas typically have complex cytogenetic abnormalities; in contrast, leiomyomas have simple or no cytogenetic abnormalities. To understand better the biological distinction(s) between these tumors, we analyzed two other potential markers of genomic instability, loss of heterozygosity (LOH) and microsatellite instability. We examined archival materials from 16 leiomyosarcomas and 13 benign leiomyomas by polymerase chain reaction for 26 microsatellite polymorphisms. Markers were selected based on previous reports of cytogenetic or molecular genetic abnormalities in leiomyosarcomas or leiomyomas and surveyed chromosomes 7, 9, 10, 11, 12, 14, 15, 16, 18, 21, and X. LOH for markers on chromosomes 15, 18, 21, and X was infrequent in leiomyosarcomas (1 of 6 tumors for each chromosome) and not observed for markers on chromosomes 7, 9, 11, 12, 14, or 16. Interestingly, 8 of 14 (57.2%) informative leiomyosarcomas had LOH for at least one marker on chromosome 10 and involved both chromosomal arms in 45.5% (5 of 11). In contrast to leiomyosarcomas, LOH for chromosome 10 was not found in 13 benign leiomyomas. Microsatellite instability was found infrequently in leiomyosarcomas and not detected in leiomyoma. Clinicopathological features (eg, atypia, necrosis, and clinical outcome) did not appear to correlate with LOH for chromosome 10. In contrast to other chromosomes studied, LOH on chromosome 10 was frequent in leiomyosarcomas and absent in benign leiomyomas.

Adult↗

PubMed1999

Lansoprazole pharmacokinetics differ in patients with oesophagitis compared to healthy volunteers.

AIM: To compare the pharmacokinetics of lansoprazole in patients with reflux oesophagitis and in healthy volunteers, after a single dose and at steady-state. PATIENTS AND METHODS: A 30 mg dose of lansoprazole was administered orally daily for 7 days in eight healthy male volunteers aged 21-24 years, and in 16 patients aged 29-65 years with grade 2 or 3 reflux oesophagitis. The pharmacokinetics were assessed over the 24 h dose interval following the first dose and again after the 7th dose. RESULTS: Within both the patient and volunteers groups, there were no significant differences between day 1 and day 7 in any of the pharmacokinetic parameters including maximum concentration (Cmax), area under the concentration-time curve (AUC), and terminal half-life of elimination (t(1/2)). However, on both days 1 and 7, values were significantly higher in the patients than in the healthy volunteers. On day 7, Cmax was 1343 ng/mL in patients compared with 765 ng/mL in healthy volunteers, AUC was 3458 ng.h/mL vs. 1350 ng.h/mL and t(1/2) was 1.62 h vs. 0.90 h. CONCLUSION: The differences in results for the pharmacokinetics reflect reduced lansoprazole clearance in the patient group. Other research has not found a difference in pharmacokinetics when comparing healthy volunteers with patients with acid-related disorders. The difference in lansoprazole clearance in this study may be related to a variety of factors that are different in patients compared with young normal volunteers, such as age, gender, other drugs, and reduced general well-being.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed1998

Adenocarcinoma of the uterine cervix metastatic to lymph nodes.

OBJECTIVE: We set out to evaluate the prognostic factors in cervical adenocarcinoma metastatic to lymph nodes. STUDY DESIGN: We performed a retrospective review of 40 patients with cervical adenocarcinoma and lymph node metastasis from 1976 to 1996. RESULTS: Thirty-four patients had adenocarcinoma, and six had adenosquamous carcinoma. Median survival was 50 months. The median survival for patients with stage I disease was 69 months. Stage at diagnosis, treatment with radical hysterectomy, and receiving adjuvant therapy were associated with prolonged survival. A trend toward improved survival was noted with the use of concurrent radiation and chemotherapy as an adjuvant therapy. CONCLUSIONS: Adenocarcinoma metastatic to the lymph nodes does not have a uniformly poor prognosis, especially with early-stage disease. Improved survival was observed with the use of adjuvant therapy, specifically the use of combined chemotherapy and radiation after radical hysterectomy. The optimal therapy in this setting is yet to be determined.

Adenocarcinoma↗

PubMed1998

Bartholinitis after vulvovaginal surgery.

OBJECTIVES: The object of the study was to determine whether obstruction of the Bartholin gland duct after vulvovaginal surgery is a cause of Bartholin gland infections or cysts. STUDY DESIGN: The records of patients with vulvovaginal surgical procedures performed by me between 1983 and 1997 were reviewed for evidence of a Bartholin gland infection or cyst formation. RESULTS: A postoperative Bartholin gland infection occurred in 2 of 217 patients with posterior colporrhaphy (with or without vault suspension) and 1 of 14 patients with partial vestibulectomy for vestibulitis. No patient had a chronic Bartholin cyst develop. CONCLUSIONS: Bartholin gland infections and Bartholin cysts are uncommon occurrences after surgical procedures that have the potential to obstruct the Bartholin duct.

Anti-Bacterial Agents↗

PubMed1998

Thermal removal of pyrene contamination from soil: basic studies and environmental health implications.

Effects of temperature (400-1000 degrees C) and rate of heating to 550 degrees C (100, 1000, 5000 degrees C/sec) on reduction of pyrene contamination in a Superfund-related soil and on yields of volatile products (tars, CO, CO2, methane, acetylene, ethylene) have been measured. Fifty (+/- 3)-milligram thin layers (less than or equal to 150 micron) of 63- to 125-micron soil particles, neat (i.e., without exogenous chemicals), or pretreated with 4.75 wt% of pyrene, were heated for about 1 to 6 sec, under 3 psig (pounds per in.(2) gauge) of helium in a 12-liter sealed chamber. Pyrene removal, defined as the difference in weight loss of neat versus contaminated soil, was virtually immune to heating rate but increased strongly with increasing temperature, approaching 100% at about 530 degrees C. However, for pyrenepolluted soil, excess soil weight loss and modified CO yields were observed above about 500 degrees C for a 1000 degrees C/sec heating rate. These observations suggest that soil chemical reactions with pyrene or pyrene decomposition products augment soil volatilization. Consequently at elevated temperatures, the difference in weight loss protocol may overestimate polycyclic aromatic hydrocarbon (PAH) removal from soil. Increasing heating rate caused yields of CO, CO(2), and acetylene from pyrene-polluted soil to pass through maxima. Heating neat or contaminated soil resulted in at least two gaseous products of particular environmental interest:acetylene, a precursor to PAH in thermal synthesis, and CO, a toxin to human hemoglobin.

Acetylene↗

PubMed1995

Fixation of the vaginal apex to the coccygeus fascia during repair of vaginal vault eversion with enterocele.

OBJECTIVE: This study was undertaken to compare the effectiveness of fixation of the vaginal apex to the coccygeus fascia with fixation to the sacrospinous ligament during surgical repair of vaginal vault eversion with enterocele. STUDY DESIGN: The records of 121 patients with posthysterectomy vaginal vault eversion with enterocele treated by the author between 1983 and 1994 were reviewed. Preoperative and postoperative symptoms and findings on pelvic examination and postoperative recovery were compared in patients undergoing sacrospinous ligament suspension and coccygeus fascial suspension. Statistical analysis was performed with chi 2 analysis and Kaplan-Meier life tables. RESULTS: Eighty-one patients underwent fixation to the coccygeus fascia and 30 underwent sacrospinous ligament suspension. The two groups are similar for clinical history, symptoms, and findings on pelvic examination. Ten patients underwent an abdominal sacral colpopexy for specific indications and are not comparable. The incidence of postoperative complications and length of hospital stay were similar for the two vaginal procedures. Patients with coccygeus fascial suspension have a projected 96% cure rate at 2 years compared with an 80% cure rate for patients with a sacrospinous ligament suspension. CONCLUSION: Bilateral vaginal vault suspension to the coccygeus fascia is a safe, simple, and effective technique in the management of vaginal vault eversion with enterocele.

Adult↗

PubMed1994

Cisplatin, doxorubicin hydrochloride, and cyclophosphamide followed by radiotherapy in high-risk endometrial carcinoma.

OBJECTIVE: Our purpose was to assess the effect of adjuvant platinum-based, multiagent chemotherapy followed by conventional radiotherapy on the recurrence-free interval, patterns of recurrence, and survival of women with completely resected, poor-prognosis endometrial carcinoma. STUDY DESIGN: Surgical stage IC and II endometrial carcinomas involving the outer one third of myometrium and completely resected stage III and IV carcinomas were eligible for six cycles of cisplatin (Platinol), doxorubicin hydrochloride (Adriamycin), and cyclophosphamide (Cytoxan) (50, 50, 500 mg/m2), followed by external beam radiotherapy to pelvis, pelvis and periaortic chain, or whole abdomen, on the basis of documented disease. RESULTS: Forty-seven women were registered between April 1, 1984, and Oct. 10, 1992; 39 were eligible for review. Six were stage I, 28 were stage III, and five were stage IV. Two tumors were grade I, eight were grade 2, and 29 were grade 3. Twenty-three were endometrioid adenocarcinomas, eight papillary serous, six adenosquamous, and two clear cell. Thirty-seven patients (94.9%) completed six courses of chemotherapy, with no deaths ascribed to treatment. Grade 3 or 4 neutropenia was experienced by 17 (44%) and sepsis by three (8%). Current median follow-up is 27.3 months. Fifteen patients (38.5%) have recurrence, and 14 have died after a median interval of 26.9 months. The 2-year progression-free interval is 72.5% for nonpapillary serous histologic types and 22.5% for papillary serous cancers (p = 0.0074). CONCLUSION: Adjuvant chemotherapy with Platinol, Adriamycin, and Cytoxan followed by radiation therapy is well tolerated and seems to confer a survival advantage to women with nonpapillary serous endometrial carcinoma with a poor prognosis compared with historic controls treated by surgery or radiotherapy.

Adult↗

PubMed1994

Uterine smooth-muscle tumors of uncertain malignant potential.

OBJECTIVE: To determine whether tumors meeting the criteria of Hendrickson and Kempson for uterine smooth-muscle tumors of uncertain malignant potential have a natural history different from those of leiomyomas and leiomyosarcomas. METHODS: Tumors with five to ten mitoses per ten high-power fields and with mild or moderate cellular atypia were classified as tumors of uncertain malignant potential. Tumors with two to four mitoses per ten high-power fields and severe cellular atypia would also be classified as tumors of uncertain malignant potential, but we had no tumors that fell into this latter group. Forty-seven women with leiomyosarcoma or smooth-muscle tumors of uncertain malignant potential were identified. Paraffin-embedded blocks were recut, and hematoxylin and eosin-stained sections were studied for mitotic counts and cellular atypia. Statistical analysis used chi 2, Fisher exact test, Student t test, and Kaplan-Meier life table analysis. RESULTS: Fifteen tumors were classified as uncertain malignant potential and 32 as leiomyosarcomas. The patients with leiomyosarcoma were significantly older and more likely to present with extrauterine disease. Those with tumors of uncertain malignant potential had a 5-year disease-free survival of 66% and overall survival of 92%, compared to 28 and 40%, respectively, for leiomyosarcomas; these differences were statistically significant. Patients with tumors of uncertain malignant potential tended to have a protracted clinical course after development of recurrence, and several survived longer than 5 years with metastatic disease. CONCLUSIONS: Patients with five to ten mitoses per ten high-power fields and mild to moderate cellular atypia had a prognosis significantly better than that of patients with leiomyosarcomas. In this group, only 27% developed a recurrence, and after recurrence they tended to have a protracted course. Some of these tumors do have a very aggressive course, and the term "uncertain malignant potential" is appropriate.

Adult↗

PubMed1993

Slope of serial glomerular filtration rate and the progression of diabetic glomerular disease.

Glomerular function was evaluated longitudinally over a 24- to 48-month period in 18 patients with diabetic glomerular disease (DGD) manifested by proteinuria. GFR was determined by iothalamate clearance at 4-month intervals. The patients were divided into two groups: Group 1 (N = 9) had subnephrotic proteinuria and an initially normal GFR of 91 +/- 8 mL/min. Group 2 (N = 9) had nephrotic-range proteinuria, and initial GFR was reduced to 53 +/- 5 mL/min. Serial GFR fluctuated over time in Group 1, but no trend towards hypofiltration was evident. In contrast, GFR declined linearly in Group 2 at 1.1 +/- 0.3 mL/min per month. The transglomerular sieving of uncharged dextrans of graded size was analyzed and initially revealed a uniform reduction in glomerular pore density and an enhancement of shuntlike pores. Pore density was initially reduced by 80% and declined further after 24 months in nephrotic Group 2; corresponding pore density in subnephrotic Group 1 was reduced by half but remained constant. Renal biopsy of four members of Group 1 revealed a 22% prevalence of global glomerulosclerosis. Remaining open glomeruli exhibited hypertrophy, excessive extracellular matrix, and deformation of epithelial podocytes. The latter abnormality appeared to be the predominant determinant of lowered ultrafiltration capacity. It was inferred that trials of therapy to attenuate the progression of DGD should be initiated at a functional level similar to that in subnephrotic Group 1. Because GFR is unlikely to decline over a 2- to 4-yr period, it is suggested that such trials be extended for longer periods. Alternatively, morphometric analysis of serial renal biopsies may shorten the time needed to demonstrate effective renoprotection in DGD.

Adult↗

PubMed1992

Deoxyribonucleic acid analysis by flow cytometry of uterine leiomyosarcomas and smooth muscle tumors of uncertain malignant potential.

OBJECTIVES: The histologic distinction of uterine benign leiomyomas from leiomyosarcomas is difficult. Ploidy analysis and measurement of the proliferative rate were examined to determine if they could distinguish malignant from benign tumors and if they were independent prognostic factors. STUDY DESIGN: Paraffin-embedded blocks were recut and prepared for flow cytometry with the technique of Hedley. Mitotic counts and tumor grading were performed on an adjacent hematoxylin and eosin-stained section. Statistical analysis was carried out with chi 2 life-table, and Cox model analysis. RESULTS: There were 33 patients with deoxyribonucleic acid histograms that were acceptable for analysis. Fourteen tumors were diploid and 19 were aneuploid. There were no significant differences in the clinical characteristics between the patients with diploid tumors and those with aneuploid tumors. Aneuploid tumors were more likely to have cellular atypia (p = 0.085). There was a strong correlation between the percentage of cells in the S phase and the mitotic count (p = 0.0001). Increasing mitotic count, increasing S phase, presence of extrauterine disease, and postmenopausal status were all adverse prognostic factors. However, when multivariant analysis with a Cox model was used, only S phase and presence of extrauterine disease were adverse factors. Diploid tumors have a better overall survival (p = 0.0658) but a similar disease-free survival. In those patients who ultimately have relapses, diploid tumors have a significantly longer interval from relapse to death (p = 0.0045). CONCLUSIONS: Neither ploidy analysis nor measurement of the proliferative rate will distinguish a benign from a malignant course in an individual patient; however, ploidy is predictive of survival from time of disease progression and proliferative rate is the strongest predictor of overall survival. The time-proven reliability of mitotic count in the diagnosis of smooth muscle tumors reflects its ability to predict proliferative rate.

DNA, Neoplasm↗

PubMed1992

Intraperitoneal P-32 is not an effective consolidation therapy after a negative second-look laparotomy for epithelial carcinoma of the ovary.

Thirty-four patients with epithelial carcinoma of the ovary were entered into a trial of adjuvant intraperitoneal P-32 following induction chemotherapy and a negative second-look laparotomy. The breakdown by initial Stage was Stage IC, 5; Stage II, 3; Stage III optimal, 22; and Stage III suboptimal, 4. Previous treatment consisted of 4-12 cycles (median 6) of cisplatin or carboplatin-based combination chemotherapy. Fifteen millicuries of P-32 were instilled via a Tenckhoff catheter placed at the time of second-look laparotomy. Because of a 22% incidence of bowel injury in the first 23 patients, the P-32 dose was reduced to 12 mCi in the last 11 patients. To date, there have been no bowel injuries at the lower dose. Eighteen of the 34 (53%) patients have relapsed with a median time to relapse of 20 months and a median follow-up for all patients of 31 months. There has been no difference in the relapse rate between a dose of 12 and 15 mCi. Intraperitoneal P-32 does not appear to reduce the relapse rate following a negative second-look laparotomy. The incidence of bowel injury is dose dependent and is higher than that seen in patients treated as an adjuvant following initial surgery without subsequent chemotherapy or second-look laparotomy.

Adult↗

PubMed1991

Invasive carcinoma after cone biopsy for cervical intraepithelial neoplasia.

A retrospective review of 578 patients with invasive cervical cancer identified 8 patients with a history of one or more cone biopsies for treatment of cervical intraepithelial neoplasia. The cone biopsy and hysterectomy specimens were reviewed to identify factors predictive of the subsequent development of invasive cancer. The mean interval from cone biopsy to diagnosis of invasive carcinoma was 6.7 years (range 1.5-16.5 years). High-grade intraepithelial neoplasia is a potentially invasive lesion. Adenocarcinoma in situ was identified as a high-risk lesion that may be inadequately treated by cone biopsy. Four patients developed invasive squamous cancer in spite of complete excision of the initial lesion. Patients who have high-grade intraepithelial neoplasia treated with cone biopsy require long-term follow-up, and conization may hamper the subsequent diagnosis of preinvasive lesions.

Adenocarcinoma↗