145 results on '"M. Penalver"'
Search Results
52. Removal of indwelling ureteral catheters with ultrasound guidance
- Author
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H N, Nguyen, F, Salman, D, Donato, H, Averette, B U, Sevin, and M, Penalver
- Subjects
Adult ,Catheters, Indwelling ,Gynecology ,Urinary Bladder ,Humans ,Female ,Stents ,Middle Aged ,Ureter ,Urinary Catheterization ,Ultrasonography - Abstract
Indwelling ureteral catheters are commonly used to splint injured ureters or to relieve obstruction. This study evaluated the possibility of using ultrasound guidance in the removal of internal ureteral catheters in women. During the 12-month period from August 1990 to August 1991, patients who desired the removal of indwelling ureteral catheters were sent to the outpatient ultrasound division instead of the urology clinic. They were instructed to come with a full bladder, or a saline infusion was required. Abdominal or vaginal ultrasound was first performed to locate the ureteral catheter. Blunt-tipped alligator forceps were used to remove the catheters under direct, real-time ultrasound guidance. A total of six catheters was removed from five patients. The average removal time was 12 +/- 4 (SD) minutes, with good patient acceptance. Further studies are required to establish the safety and efficacy of the procedure.
- Published
- 1994
53. National survey of ovarian carcinoma. VI. Critical assessment of current International Federation of Gynecology and Obstetrics staging system
- Author
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H N, Nguyen, H E, Averette, W, Hoskins, B U, Sevin, M, Penalver, and A, Steren
- Subjects
Adult ,Ovarian Neoplasms ,Middle Aged ,Prognosis ,Health Surveys ,United States ,Obstetrics ,Survival Rate ,Gynecology ,Humans ,Female ,Societies, Medical ,Aged ,Neoplasm Staging - Abstract
The Commission on Cancer of the American College of Surgeons recently completed a national survey of patients with ovarian cancer. From the large database, the prognostic value of current International Federation of Gynecology and Obstetrics (FIGO) staging system for ovarian carcinoma was re-examined.Data was collected from 25 consecutive ovarian carcinomas diagnosed in 1983 and 1988 at 904 hospitals with cancer programs. Among a total of 12,316 cases, 5156 patients had long-term survival data.The overall 5-year survivals were 88.9 +/- 0.9%; 57.1 +/- 2.4%; 23.8 +/- 1.3%; and 11.6 +/- 0.9% for Stages I, II, III, and IV, respectively. Pairwise survival comparisons using Lee-Desu statistic confirmed the prognostic value of current staging system (P0.00001). When survival data was substratified further to substage division, the 5-year survivals were: IA, 92.1 +/- 0.9%; IB, 84.9 +/- 3.4%; IC, 82.4 +/- 2.0%; IIA, 69.0 +/- 4.3%; IIB, 56.4 +/- 3.6%; IIC, 51.4 +/- 4.5%; IIIA, 39.3 +/- 2.8%; IIIB, 25.5 +/- 2.6%; IIIC, 17.1 +/- 1.4%; and IV, 11.6 +/- 0.9%. As the disease process becomes more advanced, patients' survival reduces proportionally. However, the survival reduction is relatively small between IB-IC and IIB-IIC divisions. Survival comparisons revealed significant prognostic value for most substage divisions (P = 0.03-0.0002) except for IB-IC and IIB-IIC combinations (P0.33). Further analyses revealed no significant differences between IB-IC and IIB-IIC patients in several prognostic parameters such as age, histologic grade, cell type, and amount of residual disease.These data support the current FIGO staging system. However, Substages IB-IC and IIB-IIC should be combined to respective single substages.
- Published
- 1993
54. Chemosensitivity testing in ovarian cancer
- Author
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B U, Sevin, J P, Perras, H E, Averette, D M, Donato, and M, Penalver
- Subjects
Ovarian Neoplasms ,Humans ,Female ,Drug Screening Assays, Antitumor - Abstract
Most patients with ovarian cancer currently are treated primarily with surgery and chemotherapy. Drug selection usually is not based on individualized in vitro sensitivity studies but on reported response rates of clinical trials. Attempts to include in vitro chemosensitivity testing into the management of ovarian cancer have been disappointing to clinicians. Tumor cells from fresh human ovarian cancer do not grow well under artificial in vitro growth conditions. The selection of cells that happen to proliferate in vitro (e.g., human tumor clonogenic assay) has resulted in low plating efficiencies (0.001-0.1% of plated cells). The vigorous mechanical and enzymatic tumor disaggregation, done to obtain a single-cell suspension, further reduces the number of cells that grow in vitro, resulting in low overall evaluability rates of 40-70% for the human tumor clonogenic assay. At the University of Miami, a new in vitro chemosensitivity assay was developed that detected the decrease in total tumor cell viability by measuring intracellular adenosine triphosphate as a function of in vitro drug response. Preliminary data on 31 tumor tissues from patients, which was evaluated with this method, showed a sensitivity of 92% and a specificity of 100%. Since these initial studies, data were gathered on more than 150 fresh gynecologic tumor specimens to evaluate single drugs and drug combinations at five concentrations (range, 10-500% of reported peak plasma concentrations). The evaluability rate for ovarian tumors was more than 90%. Some tumors showed almost complete cell kill at the lowest drug concentration; others had only a limited response at the highest level. Drug-response patterns also were variable for combined drug exposure. These findings underscore the heterogeneity of drug response in morphologically similar tumors and the importance of characterizing individual chemosensitivity profiles for patients before drug treatment.
- Published
- 1993
55. Oral Poster 48: Extensive Fever Workup Produces Low Yield in Determining Infectious Etiology
- Author
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E M. Salom, M Penalver, and Dana Schey
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Yield (finance) ,Immunology ,Obstetrics and Gynecology ,Medicine ,Infectious etiology ,Surgery ,business ,Dermatology - Published
- 2004
56. 186 ASSESSMENT OF LOCALIZED TISSUE CRUSH INJURY IN A PIG DUE TO A SURGICAL ENDOSCOPIC GRASPER
- Author
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J. M. Penalver, P. Casale, Suvranu De, and Blake Hannaford
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Crush injury ,General Medicine ,medicine.disease ,business ,General Biochemistry, Genetics and Molecular Biology ,Surgery - Published
- 2004
57. Assessment of Localized Tissue Crush Injury in a Pig Due to a Surgical Endoscopic Grasper
- Author
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J. M. Penalver, P. Casale, S. De, and B. Hannaford
- Subjects
General Medicine ,General Biochemistry, Genetics and Molecular Biology - Published
- 2001
58. The effects of provera on chemotherapy of uterine cancers
- Author
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James P. Perras, H. Nguyen, D. Donato, Hervy E. Averette, R. Ramos, M. Penalver, and B.U. Sevin
- Subjects
Oncology ,Chemotherapy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,medicine ,Obstetrics and Gynecology ,business - Published
- 1991
59. PRIMING WITH CISATRACURIUM A DOSE RANGING STUDY
- Author
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George B. Bikhazi, M. Penalver, K. Deepika, and C.A. Kenaan
- Subjects
Anesthesiology and Pain Medicine ,business.industry ,Medicine ,Pharmacology ,Dose-ranging study ,business ,Priming (psychology) ,Interim report - Published
- 1999
60. The Concept of Religion
- Author
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Eduardo M. Penalver
- Subjects
Establishment Clause ,Free Exercise Clause ,Law ,Sociology - Published
- 1997
61. Radiation enhancement of Gemcitabine® In three human cervical cancer cell lines
- Author
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R. Angioli, R. Kurek, B.-U. Sevin, E. Eble, J. Blatter, Diethelm Wallwiener, M. Penalver, G. Bastert, M. Janicek, and Ingo J. Diel
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cervical carcinoma ,medicine ,business ,Gemcitabine ,medicine.drug - Published
- 1997
62. Evidence of tumor heterogeneity in cervical cancers and metastatic lymph nodes as determined by flow cytometry
- Author
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M. Penalver, D. Donato, B.U. Sevin, H. Nguyen, Hervy E. Averette, R. Ramos, James P. Perras, and Parvin Ganjei
- Subjects
Oncology ,medicine.medical_specialty ,Pathology ,medicine.diagnostic_test ,business.industry ,Internal medicine ,medicine ,Obstetrics and Gynecology ,Lymph ,business ,Tumor heterogeneity ,Flow cytometry - Published
- 1992
63. Preliminary experience of a modified Tenckhoff catheter for repetitive intraperitoneal chemotherapy
- Author
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B.U. Sevin, D. Donato, Hervy E. Averette, H. Nguyen, L. Wyble, and M. Penalver
- Subjects
Tenckhoff catheter ,medicine.medical_specialty ,Oncology ,business.industry ,Anesthesia ,medicine ,Obstetrics and Gynecology ,Intraperitoneal chemotherapy ,business ,Surgery - Published
- 1992
64. A phase I study of escalating dose trental with cisplatin in advanced or recurrent gynecologic cancer: A chemomodulation regimen
- Author
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G. Boike, M. Penalver, D. Donato, Sterling E. Sightler, and Hervy E. Averette
- Subjects
Cisplatin ,Oncology ,Regimen ,medicine.medical_specialty ,business.industry ,Internal medicine ,Gynecologic cancer ,medicine ,Obstetrics and Gynecology ,business ,medicine.drug ,Phase i study - Published
- 1992
65. Functional characteristics and follow-up of the continent ileal colonic urinary reservoir
- Author
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B.U. Sevin, M. Penalver, D. Donato, and Hervy E. Averette
- Subjects
medicine.medical_specialty ,Oncology ,business.industry ,Urology ,Obstetrics and Gynecology ,Medicine ,Urinary reservoir ,business - Published
- 1992
66. The role of DNA index as a prognostic factor in stage IB-IIA cervical cancers
- Author
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B.U. Sevin, M. Penalver, Hervy E. Averette, D. Donato, R. Ramos, Parvin Ganjei, H. Nguyen, and James P. Perras
- Subjects
Oncology ,Stage ib ,medicine.medical_specialty ,Prognostic factor ,business.industry ,Internal medicine ,medicine ,Obstetrics and Gynecology ,Dna index ,business - Published
- 1992
67. Comparative evaluation of pirarubicin and adriamycin in gynecologic cancer
- Author
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M. Penalver, B.U. Sevin, James P. Perras, H. Nguyen, R. Ramos, Hervy E. Averette, and D. Donato
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,Pirarubicin ,Gynecologic cancer ,medicine ,Obstetrics and Gynecology ,business ,Comparative evaluation ,medicine.drug - Published
- 1991
68. Continent urinary diversion in gynecologic oncology
- Author
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Bernd-Uwe Sevin, George M. Suarez, M. Penalver, HE Averette, D. Donato, and Darwich E. Bejany
- Subjects
Reoperation ,medicine.medical_specialty ,Colon ,Genital Neoplasms, Female ,medicine.medical_treatment ,Urology ,Anastomosis ,Urinary Diversion ,Ileocecal valve ,Stoma (medicine) ,Ileum ,medicine ,Ascending colon ,Humans ,Pelvic exenteration ,business.industry ,Urinary diversion ,Transverse colon ,Obstetrics and Gynecology ,General Medicine ,digestive system diseases ,Surgery ,Urodynamics ,medicine.anatomical_structure ,Oncology ,Female ,business ,Continent Urinary Diversion ,Follow-Up Studies - Abstract
Pelvic exenteration is a salvage procedure used primarily for recurrent gynecologic carcinoma. Up to the present time, an ileal or colon conduit has been used for urinary diversion and the patient remains incontinent of urine. This is a preliminary report of nine patients with gynecologic carcinoma in whom a continent urinary diversion procedure was performed. A segment of distal ileum, the ascending colon, and part of the transverse colon are used to create the colonic reservoir. The segment of colon is opened along the tenia and folded onto itself. The walls of the ascending and transverse colon are anastomosed to detubularize this segment of bowel and eliminate the transient high pressure of the colon. Surgical staples are used for the anastomosis. The segment of ileum is tapered and three purse-string sutures (2-O silk) are placed at the level of the ileocecal valve to achieve continence. The short segment of ileum is then exteriorized as a stoma through which the patient catheterizes. Antirefluxing, non-tunneled ureterocolonic anastomoses are performed. The anterior wall of the reservoir is closed with absorbable staples. Postoperative urodynamic studies have shown maximum capacity of 750 ml and the area of continence to be at the ileocecal valve where the purse-string sutures are placed. All patients are continent and postoperative radiographs were negative for reflux. Follow-up was 6 to 12 months. The colonic reservoir is a capacious low-pressure system and warrants further clinical trials in patients with gynecologic cancer.
- Published
- 1989
69. Lymphangioma circumscriptum of the vulva: case report and review of the literature
- Author
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A, Abu-Hamad, D, Provencher, P, Ganjei, and M, Penalver
- Subjects
Adult ,Lymphangioma ,Vulvar Neoplasms ,Humans ,Female ,Vulva - Abstract
Lymphangioma circumscriptum is a benign disorder of lymphatic channels. The pathology consists of a collection of subcutaneous lymphatic cisterns communicating through dilated channels with superficial clusters of vesicles. The most common symptom is recurrent oozing of clear fluid. Management consists of wide excision, assuring free lateral and deep margins by frozen-section analysis. Involved margins have been shown to increase the recurrence rate. Laser vaporization has been used recently with relatively good results. The etiology of this lesion is unclear; however, lymphatic obstruction has been suggested as a possible cause in occasional cases. Two cases of vulvar lymphangioma circumscriptum have been reported previously in the literature, both arising in elderly women after radiation therapy for squamous cell carcinoma of the cervix. We present the third case, arising in a 42-year-old woman with no previous surgery or radiation.
- Published
- 1989
70. [Insecticidal experiments with dieldrin in the anti-Triatoma campaign]
- Author
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L M, PENALVER and E, VILLAGRAN
- Subjects
Dieldrin ,Insecticides ,Insecta ,Animals ,Humans ,Triatoma - Published
- 1955
71. [Scientific research in universities and medical schools]
- Author
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L M, PENALVER
- Subjects
Schools ,Universities ,Research ,Humans ,Schools, Medical - Published
- 1962
72. [Human trypanosomiasis in El Salvador; preliminary report. I. Epidemiological investigations]
- Author
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L M, PENALVER, M I, RODRIGUEZ, and G, SANCHO
- Subjects
Trypanosomiasis ,El Salvador ,Humans ,Chagas Disease ,Hispanic or Latino ,United States - Published
- 1956
73. [Human trypanosomiasis in El Salvador; preliminary report. II. Cardiovascular aspects]
- Author
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M I, RODRIGUEZ and L M, PENALVER
- Subjects
Electrocardiography ,Trypanosomiasis ,El Salvador ,Humans ,Chagas Disease ,Hispanic or Latino ,Cardiovascular System ,United States - Published
- 1956
74. [Diagnosis of malaria in the hospital milieu; analysis of cases registered at Rosales Hospital 1949-54]
- Author
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L M, PENALVER, R, MARTINEZ QUEHL, and J A, RODRIGUEZ
- Subjects
Diagnosis, Differential ,Humans ,Rosales ,Hospitals ,Malaria - Published
- 1956
75. [New data on trypanosomiasis in El Salvador]
- Author
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L M, PENALVER, M I, RODRIGUEZ, and G, SANCHO
- Subjects
Trypanosomiasis ,El Salvador ,Humans ,Chagas Disease ,Hispanic or Latino ,United States - Published
- 1957
76. HIV status and routine papanicolaou screening: Identification of a high-risk population
- Author
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D. Provencher, B. Valme, P. Ganjei, D. Donato, M. Penalver, B.U. Sevin, and H.E. Averette
- Subjects
Oncology ,Obstetrics and Gynecology - Published
- 1988
77. Continent urinary diversion in gynecologic oncology
- Author
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D. Donato, M. Penalver, Darwich E. Bejany, B.U. Sevin, and Hervy E. Averette
- Subjects
medicine.medical_specialty ,Oncology ,business.industry ,medicine.medical_treatment ,General surgery ,Urinary diversion ,Obstetrics and Gynecology ,Medicine ,Gynecologic oncology ,business - Published
- 1989
78. Accessibility to Obstetric Care in South Florida Based on Insurance: A Cross-Sectional Study.
- Author
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Kolesova M, Sarantos S, Alvarez J, Torres A, Pateriya S, and Penalver M
- Abstract
Introduction Obstetrical research confirms that earlier onset prenatal care significantly improves pregnancy and birth outcomes. Initiating care in the second trimester or having less than 50% of recommended visits has been associated with an increased risk of prematurity, stillbirth, neonatal, and infant death. Studies have shown that women on public health insurance plans initiate prenatal care substantially later into pregnancy than those on private plans. The purpose of this study is to assess whether public health insurance limits Florida patients' access to obstetric care. Methods A cross-sectional study was conducted by collecting data on the four most populated zip codes for Medicaid in South Florida using HealthGrades.com. The following search parameters were used: "obstetric care", "four stars and up" and "10-mile distance". Each obstetrician was called three times to assess appointment availability for fictional nulliparous women at eight weeks of gestation requesting prenatal care. Accepted insurance types (Medicaid, Cigna, and United Health Group (UHG)), time to an appointment in business days, and self-pay rates were recorded. Practices with invalid contact information and retired obstetricians were excluded. Summary statistics, chi-squared analysis, and a two-way t-test were conducted for the primary outcome. Results Seventy-one out of 178 obstetricians were successfully contacted, of which 31 physicians accepted all three insurances, and 40 physicians did not accept at least one insurance. Of those, 97.2% accepted UnitedHealthcare, 98.6% accepted Cigna, and 45.1% accepted Medicaid. There was a statistically significant difference when comparing acceptance rates between UHC and Medicaid as well as Cigna and Medicaid (p<0.001). There was no statistically significant difference in acceptance rates in the direct comparison of the two private insurances, Cigna and UnitedHealthcare (p=0.559). The average number of days until the next available appointment was 12.7 (SD= 7.2) for UnitedHealthcare, 20.0 (SD=6.7) for Cigna, and 17.0 (SD=8.6) for Medicaid. There was a statistically significant trend between the type of insurance and the time to the earliest appointment (p=0.002). Conclusion This study demonstrated patients enrolled in Medicaid in South Florida have significantly less access to prenatal care than those with private insurance. This evidence shows that decreased access to care from Medicaid plans can possibly increase the risk of adverse outcomes associated with inadequate prenatal care. This information should be considered by policymakers when considering future Medicaid expansion., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kolesova et al.)
- Published
- 2023
- Full Text
- View/download PDF
79. Urinary diversion after exenterative surgery: continent conduit remains my ideal approach.
- Author
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Penalver M
- Subjects
- Humans, Prostheses and Implants, Urinary Bladder, Urinary Diversion
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2021
- Full Text
- View/download PDF
80. Surgical treatment of acute abdominal complications in hematology patients: outcomes and prognostic factors.
- Author
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Mokart D, Penalver M, Chow-Chine L, Ewald J, Sannini A, Brun JP, Bisbal M, Lelong B, Delpero JR, Faucher M, and Turrini O
- Subjects
- Emergencies, Hospital Mortality, Humans, Prognosis, Retrospective Studies, Risk Factors, Survival Rate, Abdominal Pain etiology, Hematologic Neoplasms complications, Neutropenia complications, Shock, Septic etiology, Thrombocytopenia complications
- Abstract
The decision to operate on hematology patients with abdominal emergencies can be difficult, as neutropenia and thrombocytopenia are common and the usual causes of abdominal pain are broad. We conducted a retrospective observational study including all hematology patients undergoing emergency abdominal surgery between January 1998 and January 2013. Of the fifty-eight consecutive patients included in the study, nineteen (33%) underwent an operation during the neutropenia period. In the multivariate analysis, a laparotomy after 2002 was protective (HR: 0.05; 95%CI: 0.001-0.24), whereas preoperative septic shock (HR: 8.58; 95%CI: 2.25-32.63) and use of dialysis (HR: 6.67; 95%CI: 2.11-21.07) were independently associated with hospital mortality. Surgery during neutropenia or thrombocytopenia was not associated with prognosis. In hematology patients, emergency abdominal surgery is associated with encouraging hospital survival rates. Surgery should be performed prior to septic shock, regardless of whether neutropenia or thrombocytopenia is present.
- Published
- 2017
- Full Text
- View/download PDF
81. The microculture-kinetic (MiCK) assay: the role of a drug-induced apoptosis assay in drug development and clinical care.
- Author
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Bosserman L, Prendergast F, Herbst R, Fleisher M, Salom E, Strickland S, Raptis A, Hallquist A, Perree M, Rajurkar S, Karimi M, Rogers K, Davidson D, Willis C, Penalver M, Homesley H, Burrell M, Garrett A, Rutledge J, Chernick M, and Presant CA
- Subjects
- Antineoplastic Agents chemistry, Cell Line, Tumor, Chronic Disease, Drug Discovery methods, HL-60 Cells, Humans, Leukemia drug therapy, Leukemia pathology, Neoplasms pathology, Antineoplastic Agents pharmacology, Apoptosis drug effects, Drug Screening Assays, Antitumor methods, Neoplasms drug therapy
- Abstract
A drug-induced apoptosis assay, termed the microculture-kinetic (MiCK) assay, has been developed. Blinded clinical trials have shown higher response rates and longer survival in groups of patients with acute myelocytic leukemia and epithelial ovarian cancer who have been treated with drugs that show high apoptosis in the MiCK assay. Unblinded clinical trials in multiple tumor types have shown that the assay will be used frequently by clinicians to determine treatment, and when used, results in higher response rates, longer times to relapse, and longer survivals. Model economic analyses suggest possible cost savings in clinical use based on increased generic drug use and single-agent substitution for combination therapies. Two initial studies with drugs in development are promising. The assay may help reduce costs and speed time to drug approval. Correlative studies with molecular biomarkers are planned. This assay may have a role both in personalized clinical therapy and in more efficient drug development., (©2012 AACR.)
- Published
- 2012
- Full Text
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82. Correlation of pretreatment drug induced apoptosis in ovarian cancer cells with patient survival and clinical response.
- Author
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Salom E, Penalver M, Homesley H, Burrell M, Garrett A, Presant CA, Rutledge J, Chernick M, Hallquist A, and Perree M
- Subjects
- Antineoplastic Combined Chemotherapy Protocols pharmacology, Female, Humans, Ovarian Neoplasms pathology, Survival Rate, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Apoptosis drug effects, Ovarian Neoplasms drug therapy
- Abstract
Background: This study was performed to determine if a chemotherapy-induced apoptosis assay (MiCK) could predict the best therapy for patients with ovarian cancer., Methods: A prospective, multi-institutional and blinded trial of the assay was conducted in 104 evaluable ovarian cancer patients treated with chemotherapy. The MiCK assay was performed prior to therapy, but treating physicians were not told of the results and selected treatment only on clinical criteria. Outcomes (response, time to relapse, and survival) were compared to the drug-induced apoptosis observed in the assay., Results: Overall survival in primary therapy, chemotherapy naïve patients with Stage III or IV disease was longer if patients received a chemotherapy which was best in the MiCK assay, compared to shorter survival in patients who received a chemotherapy that was not the best. (p < 0.01, hazard ratio HR 0.23). Multivariate model risk ratio showed use of the best chemotherapy in the MiCK assay was the strongest predictor of overall survival (p < 0.01) in stage III or IV patients. Standard therapy with carboplatin plus paclitaxel (C + P) was not the best chemotherapy in the MiCK assay in 44% of patients. If patients received C + P and it was the best chemotherapy in the MiCK assay, they had longer survival than those patients receiving C + P when it was not the best chemotherapy in the assay (p = 0.03). Relapse-free interval in primary therapy patients was longer if patients received the best chemotherapy from the MiCK assay (p = 0.03, HR 0.52). Response rates (CR + PR) were higher if physicians used an active chemotherapy based on the MiCK assay (p = 0.03)., Conclusion: The MiCK assay can predict the chemotherapy associated with better outcomes in ovarian cancer patients. This study quantifies outcome benefits on which a prospective randomized trial can be developed.
- Published
- 2012
- Full Text
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83. Extensive fever workup produces low yield in determining infectious etiology.
- Author
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Schey D, Salom EM, Papadia A, and Penalver M
- Subjects
- Adult, Blood microbiology, Body Temperature, Confidence Intervals, Female, Fever physiopathology, Humans, Hysterectomy, Leukocyte Count, Middle Aged, Odds Ratio, Postoperative Period, Predictive Value of Tests, Retrospective Studies, Time Factors, Urine microbiology, Fever microbiology, Gynecologic Surgical Procedures, Infections diagnosis
- Abstract
Objective: The study was undertaken to evaluate the use of a fever workup in women undergoing benign gynecologic procedures., Study Design: A retrospective chart review was performed at Jackson Memorial Hospital between 1994 and 2000. Information was abstracted from hospital and clinic records. Fever criteria was defined as 1 temperature equal to or greater than 101.5, or 2 equal to or greater than 100.4, at least 4 hours apart within a 24-hour period. Patients undergoing additional intraoperative procedures leading to increased febrile morbidity were excluded. Data abstracted included patient demographics, procedure, complications, antibiotic use, and extent of fever workup. Statistical analysis used was 2-sample t tests, Wilcoxon rank test, chi2 test, and multivariate logistic regression. Alpha level = .05., Results: The charts of 505 patients were reviewed, and 147 patients met fever criteria. All patients underwent surgery for benign conditions, abdominal hysterectomy being the most common (90%). The study population was divided into 2 groups: the noninfectious group and infectious group. These groups were determined by wound infection, pelvic abscess, blood or urine culture, ultrasound, and chest roentgen. Both groups were found to be similar with respect to demographics, surgical procedures, and postoperative complications, with the exception of body mass index (28.4 vs 31.7) and length of hospital stay (3.9 vs 5.3). Results from fever workups included positive results blood cultures (9.7%), urine culture (18.8%), and chest roentgens (14%) in this study population. We found no association between positive urine analysis and urine culture. When comparing both groups, a statistically significant difference was found with regard to maximum temperature elevation, number of days febrile, and postoperative day of maximum temperature (P < .05)., Conclusion: The extensive fever workup was not frequently positive in this study population. Its use and cost-effectiveness should be questioned. Therefore, the fever workup should be tailored to the individual patient.
- Published
- 2005
- Full Text
- View/download PDF
84. Guidelines of how to manage vesicovaginal fistula.
- Author
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Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F, Crocè C, and Panici PB
- Subjects
- Algorithms, Female, Gynecologic Surgical Procedures methods, Humans, Practice Guidelines as Topic, Vesicovaginal Fistula diagnosis, Vesicovaginal Fistula etiology, Vesicovaginal Fistula surgery
- Abstract
Vesicovaginal fistulas are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing vesicovaginal fistula is more than 1% after radical surgery and radiotherapy for gynecologic malignancies. Management of these fistulas has been better defined and standardized over the last decade. We describe in this paper the success rate reported in the literature by treatment modality and the guidelines used at our teaching hospitals, University of Rome Campus Biomedico and University of Miami School of Medicine. In general, our preferred approach is a trans-vaginal repair. To the performance of the surgical treatment, we recommend a minimum of a 4-6 week's wait from the onset of the fistula. The vaginal repair techniques can be categorized as to those that are modifications of the Latzko procedure or a layered closure with or without a Martius flap. The most frequently used abdominal approaches are the bivalve technique or the fistula excision. Radiated fistulas usually require a more individualized management and complex surgical procedures. The rate of successful fistula repair reported in the literature varies between 70 and 100% in non-radiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91 and 97%, respectively. Fistulas in radiated patients are less frequently repaired and the success rate varies between 40 and 100%. In this setting many institutions prefer to perform a urinary diversion. In conclusion, the vaginal approach of vesicovaginal fistulas repair should be the preferred one. Transvaginal repairs achieve comparable success rates, while minimizing operative complications, hospital stay, blood loss, and post surgical pain. We recommend waiting at least 4-6 weeks prior to attempting repair of a vesicovaginal fistula. It is acceptable to repeat the repair through a vaginal approach even after a first vaginal approach failure. In the more individualized management of fistulas associated with radiation, the vaginal approach should still be considered.
- Published
- 2003
- Full Text
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85. Continent urinary diversion and low colorectal anastomosis after pelvic exenteration. Quality of life and complication risk.
- Author
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Angioli R, Panici PB, Mirhashemi R, Mendez L, Cantuaria G, Basile S, and Penalver M
- Subjects
- Anastomosis, Surgical methods, Colorectal Surgery adverse effects, Colorectal Surgery methods, Female, Humans, Postoperative Complications, Quality of Life, Urinary Diversion methods, Anastomosis, Surgical adverse effects, Pelvic Exenteration, Urinary Diversion adverse effects
- Abstract
Introduction: Pelvic exenteration is one of the most destructive gynecologic operations performed on an elective basis, with consequent detrimental effects on the quality of life. The use of reconstructive surgery has significantly improved the quality of life of women undergoing this type of procedure. In this paper we review our experience with continent urinary diversion (Miami Pouch) and low colorectal anastomosis at the Division of Gynecologic Oncology of the University of Miami., Methods: Patients who underwent creation of the continent urinary diversion Miami Pouch from 1988 to 1997 and supralevator pelvic exenteration with low colorectal resection and primary anastomosis from 1990 to 1997 have been included in this study. Management of complications, with particular emphasis on the conservative treatment, has been reviewed in detail for each patient. Open surgery and conservative treatment have been compared. Analysis of complications in irradiated and nonirradiated patients was performed., Results: 77 patients who underwent creation of the Miami Pouch entered this study. Forty patients underwent total pelvic exenteration, and 37 patients underwent posterior exenteration. The most common urinary complications were ureteral stricture/obstruction (22.1%), difficult catheterisation (19.5%) and pyelonephritis (16.9%). Conservative management strategies were successfully used in 80% of the complications. Analysis of breakdown and fistula formation after low colorectal anastomosis was performed on 77 patients. Thirty-five percent of the irradiated patients developed anastomotic breakdown or fistulas, while the occurrence of this type of complications was only 7.5% in the nonirradiated group., Conclusions: Reconstructive procedures after pelvic exenteration present a significant risk of complications, especially in irradiated patients. Most of the complications related to the creation of continent urinary diversion can safely be treated conservatively. Low colorectal anastomosis carries an acceptable risk of complications in nonirradiated patients, but the risk in irradiated patients is very high, therefore, detailed patient selection and extensive counselling in these groups of patients is mandatory.
- Published
- 2003
- Full Text
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86. Innovations in the treatment of invasive cervical cancer.
- Author
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Stehman FB, Rose PG, Greer BE, Roy M, Plante M, Penalver M, Jhingran A, Eifel P, Montz F, and Wharton JT
- Subjects
- Combined Modality Therapy, Female, Humans, Neoplasm Invasiveness, Pelvic Exenteration, Research, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms drug therapy, Uterine Cervical Neoplasms radiotherapy, Uterine Cervical Neoplasms surgery, Uterine Cervical Neoplasms therapy
- Abstract
Invasive cervical cancer is characterized by basement membrane-invading lesions capable of metastasizing through the lymphatic and vascular systems. Treatment methods were reviewed by panelists at the Second International Conference on Cervical Cancer (Houston, TX, April 11-14, 2002), and new opportunities for translational research were discussed. Reviews encompassed hysterectomy with or without lymph node dissection or cervical conization in cases with microinvasion and radical trachelectomy with or without lymph node dissection as fertility-sparing surgery. Chemoradiation is used to treat advanced cervical malignancies, and the risks and benefits of radiotherapy are significant. Pelvic exenteration is used to treat certain types of recurrences. Use of the Miami pouch for continent urinary diversion was highlighted. Gynecologic oncologists expect novel in vivo imaging techniques currently being developed to help guide therapy choices within the next decade. The most significant research priorities are large group-randomized trials involving fertility-sparing procedures and the management of microinvasive carcinoma (MICA); better identification of candidates for chemoradiation; and the development of innovative approaches to exenteration. Improving diagnostic technologies, refining the criteria by which therapies are chosen, and preserving fertility remain challenges in selecting the most appropriate treatment for invasive cervical cancer. Research advances in both diagnosis and treatment are expected to improve therapy and outcomes., (Copyright 2003 American Cancer Society.)
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- 2003
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87. Expression of glucose transporter-1 in cervical cancer and its precursors.
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Mendez LE, Manci N, Cantuaria G, Gomez-Marin O, Penalver M, Braunschweiger P, and Nadji M
- Subjects
- Adult, Aged, Aged, 80 and over, Disease Progression, Female, Gene Expression Regulation, Neoplastic, Glucose Transporter Type 1, Humans, Immunohistochemistry, Middle Aged, Monosaccharide Transport Proteins immunology, Neoplasm Invasiveness, Up-Regulation, Monosaccharide Transport Proteins analysis, Uterine Cervical Neoplasms chemistry, Uterine Cervical Dysplasia chemistry
- Abstract
Objective: Increased glucose uptake and utilization is a known phenomenon exhibited by malignant cells. Overexpression of the glucose transporter protein family is thought to be the principal mechanism by which these cells achieve up-regulation. Our purpose is to determine glucose transporter-1 (GLUT 1) expression in squamous carcinoma of the cervix and precursor lesions., Methods: Archival histologic sections were obtained from 31 cases of invasive squamous cell carcinoma (SCC) of the uterine cervix, 15 cases of high-grade cervical intraepithelial neoplasia, 5 cases of low-grade, and 9 normal cervices. Immunohistochemistry for GLUT 1 protein was performed using polyclonal GLUT 1 antibody (Dako, Carpinteria, CA) and the labeled streptavidin-biotin procedure., Results: Compared to the internal control, the pattern of staining varied from weak (1+) to strong (3+) reactions. In normal cervix, 1+ GLUT 1 staining was seen in the basal cells of the squamous epithelium. All 31 (100%) cases of SCC were positive for GLUT 1. Positive reactions seemed more intense in tumor cells that were farther away from the stromal blood supply. There was a correlation between intensity of reaction for GLUT 1 and histologic grade of tumor (P = 0.0027) and with progression from normal or dysplastic lesions to invasive cancer (P = 0.0001). Intensity was a predictor of the presence of poorly differentiated tumor type. Low-grade CIN staining was seen in less than one-third of the epithelium, while in high-grade lesions the reaction was present in over one-half of the epithelium., Conclusions: GLUT 1 is overexpressed in cervical carcinoma. The process appears to be related to grade of tumor but not to the progression from preneoplastic lesions. The results suggest that GLUT 1 overexpression is a late phenomenon in cellular transformation. Furthermore, the possible relation of expression to tumor blood supply suggests that the malignant cells may have an adaptive environmental ability to compensate for a compromised microenvironment.
- Published
- 2002
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88. What's new in obstetrics and gynecology.
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Penalver M, Mendez LE, and Lambrou N
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- Cryopreservation, Fellowships and Scholarships, Female, Fertility, Genital Neoplasms, Female surgery, Humans, Obstetrics education, Plastic Surgery Procedures, Reproductive Techniques, Assisted, Urology education, Vagina surgery, Genital Diseases, Female surgery, Gynecologic Surgical Procedures, Gynecology education, Gynecology trends
- Published
- 2002
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- View/download PDF
89. Candidate Gene in Predicting In Vivo Ovarian Cancer Response to Combination Therapy with Paraplatin and Paclitaxel.
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Mirhashemi R, Arena JF, Frudakis T, Lambrou N, Arboleda J, Hunt M, Medranda M, Averette H, and Penalver M
- Published
- 2002
- Full Text
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90. Radical vaginal trachelectomy after supracervical hysterectomy.
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Mendez LE, Penalver M, McCreath W, Bejarano P, and Angioli R
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Uterine Diseases surgery, Vagina surgery, Gynecologic Surgical Procedures methods, Hysterectomy methods, Uterine Cervical Neoplasms surgery
- Abstract
Background: Radical vaginal trachelectomy (RVT) is an acceptable approach when applied toward a select group of patients with early stage cervical carcinoma. It is less invasive, can maintain fertility, and can be ideal in patients with significant comorbid factors compared to abdominal approaches. A small subset of patients with a previous supracervical hysterectomy can pose a surgical dilemma., Case: An 81-year-old woman with a history of severe cardiac disease on routine gynecological examination was found to have adenocarcinoma in situ with a focus suspicious for invasion of the cervical stump diagnosed by cone biopsy. She previously had a supracervical hysterectomy for benign disease of the uterus. A RVT was performed as definitive treatment and the patient recovered without complications., Conclusion: In the rare case that presents with a history of supracervical hysterectomy, RVT with some technical modifications can still be considered as a therapeutic option for early stage cervical carcinoma.
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- 2002
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91. Malignant peripheral nerve sheath tumor of the vulva: a multimodal treatment approach.
- Author
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Lambrou NC, Mirhashemi R, Wolfson A, Thesiger P, and Penalver M
- Subjects
- Adult, Chemotherapy, Adjuvant, Female, Humans, Nerve Sheath Neoplasms drug therapy, Nerve Sheath Neoplasms radiotherapy, Nerve Sheath Neoplasms surgery, Neurofibromatosis 1 complications, Radiotherapy, Adjuvant, Vulvar Neoplasms drug therapy, Vulvar Neoplasms radiotherapy, Vulvar Neoplasms surgery, Nerve Sheath Neoplasms therapy, Vulvar Neoplasms therapy
- Abstract
Background: Malignant peripheral nerve sheath tumors (MPNSTs) are rare in the gynecological population and have a high risk for local and distant failures. Multimodal management of a patient with MPNST of the vulva and review of the literature are outlined., Case: A 34-year-old woman presented with a complaint of a rapidly increasing pelvic mass, pain, and difficulty ambulating. A disfiguring 20 x 20-cm vulvar mass was identified and a recurrent MPNST diagnosed. Therapy included external-beam radiation, anterior pelvic exenteration with pelvic reconstruction, and adjuvant chemotherapy without complication., Conclusion: It is recommended that for malignant peripheral nerve sheath tumors of the vulva, complete surgical resection be performed with adjuvant radiation and chemotherapy in selected cases., ((c) 2002 Elsevier Science (USA).)
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- 2002
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92. Recurrent vulvar cancer.
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Salom EM and Penalver M
- Subjects
- Antineoplastic Agents administration & dosage, Carcinoma, Squamous Cell secondary, Cisplatin administration & dosage, Combined Modality Therapy, Female, Fluorouracil administration & dosage, Humans, Practice Guidelines as Topic, Vulvar Neoplasms pathology, Carcinoma, Squamous Cell therapy, Neoplasm Recurrence, Local therapy, Vulvar Neoplasms therapy
- Abstract
Recurrent vulvar cancer occurs in an average of 24% of cases after primary treatment after surgery with or without radiation. The relatively few primary vulvar cancers, combined with the low proportion of recurrences, has made it difficult to perform randomized studies to document the most appropriate therapeutic modalities. Most reports are small retrospective studies and anecdotal reviews that have emphasized the importance of surgery and have led to new approaches with respect to chemoradiation. Traditionally, the most accepted treatment of vulvar cancer has been and continues to be surgery. Recently, radiation and chemotherapy have been combined with very encouraging results. The therapeutic modality used depends on the location and extent of the recurrence. Most recurrences occur locally near the original resection margins or at the ipsilateral inguinal or pelvic lymph nodes. Lateralized local vulvar recurrences treated with a wide radical local excision with inguinal lymphadectomy results in an excellent cure rate of 70%. With a central pelvic recurrence with antecedent radiotherapy involving the urethra, upper vagina, and rectum, total pelvic exenteration is indicated in a select group of patients with curative intent. Radiotherapy or chemoradiation concomitantly with wide radical local excision of an advanced vulvar has proven successful in avoiding an exenteration, with improved survival and less morbidity. Prospective and retrospective studies have shown excellent results using radiation or chemoradiation with wide radical local excision in patients with locally advanced disease in whom adequate resection margins are difficult to achieve (with a central lesion requiring exenteration) or with debilitating medical conditions that preclude surgery. In these patients, chemoradiation has shown favorable results when used before a wide local resection. In patients with advanced local disease, external beam and interstitial radiation has been used for palliative and curative intent with encouraging results. Regional recurrences to the inguinal and pelvic lymph nodes have been shown to have a poor prognosis with a high mortality rate. We recommend that inguinal recurrences without prior radiation therapy undergo excision followed by radiotherapy with chemosensitization. In patients with previous radiation to the inguinal lymph nodes, we try to avoid any excisional procedures because of the high rate of complications. We offer these patients brachytherapy for palliation. With pelvic recurrences, we recommended chemoradiation as the treatment modality. In the subset of patients with distant metastasis, chemotherapy may be offered; however, few studies have been performed to advocate any single combination. The literature supports the use of 5-fluorouracil or cisplatin as single agents or in combination to have sensitivity against squamous cells. There are few studies revealing improvement in 5-year survival, thus these patients may benefit from recruitment into research protocols.
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- 2002
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93. GLUT-1 expression in ovarian carcinoma: association with survival and response to chemotherapy.
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Cantuaria G, Fagotti A, Ferrandina G, Magalhaes A, Nadji M, Angioli R, Penalver M, Mancuso S, and Scambia G
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- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma drug therapy, Carcinoma pathology, Female, Glucose Transporter Type 1, Humans, Immunohistochemistry, Middle Aged, Multivariate Analysis, Ovarian Neoplasms drug therapy, Ovarian Neoplasms pathology, Survival Analysis, Carcinoma metabolism, Monosaccharide Transport Proteins metabolism, Ovarian Neoplasms metabolism
- Abstract
Background: Cancer cell growth is an energy-related process supported by an increased glucose metabolism. The objective of this study was to investigate the association of GLUT-1 with response to chemotherapy and outcome in patients with ovarian carcinoma., Methods: Histologic sections of formalin fixed, paraffin embedded specimens from 113 primary ovarian carcinomas were stained for GLUT-1 by using polyclonal GLUT-1 antibody (Dako Co., Carpinteria, CA) and the labeled streptavidin biotin procedure. Intensity of GLUT-1 staining was compared with disease free survival (DFS), chemotherapy response, and other clinicopathologic characteristics., Results: GLUT-1 cytoplasmic membrane staining was observed in 89 of 104 (85.6%) malignant tumors. Poorly differentiated tumors showed a trend to overexpress the GLUT-1 protein compared with the more differentiated counterparts (27.6% vs. 8.7%; P = 0.08). Patients who experienced a complete clinical response to chemotherapy were more frequently GLUT-1 positive than GLUT-1 negative (80% vs. 51.5%; P = 0.036). In multivariate analysis of advanced stage disease, residual tumor (P = 0.0001) and high GLUT-1 expression levels (P = 0.028) were the only independent variables that maintained a significant association with response to chemotherapy (P = 0.0001; chi-square = 38.13). In the subgroup of Stage III-IV (International Federation of Gynecology and Obstetrics patients showing a complete clinical response, GLUT-1 overexpression was associated with a shorter DFS. The median time to progression was 30 months in GLUT-1 strongly positive cases (> 50% of cancer cells positive) versus 60 months in GLUT-1 weakly positive cases (< or = 50% of cancer cells positive; P = 0.024)., Conclusions: GLUT-1 status is an independent prognostic factor of response to chemotherapy in advanced stage ovarian carcinoma. Moreover, patients overexpressing GLUT-1 show a significantly shorter DFS. These results suggest that the assessment of GLUT-1 status may provide clinically useful prognostic information in patients with ovarian carcinoma., (Copyright 2001 American Cancer Society.)
- Published
- 2001
- Full Text
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94. Urinary diversion in gynecologic oncology.
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Estape R, Mendez LE, Angioli R, and Penalver M
- Subjects
- Female, Humans, Genital Neoplasms, Female surgery, Urinary Diversion
- Abstract
Urinary diversion in gynecology is performed primarily in conjunction with cancer surgery, but at times, it is required for women with intractable urinary fistulas or other urologic disorders. After 1950, ileal conduits replaced ureterosigmoidostomies as the most widely used form of urinary diversion. Transverse colon conduits have gained popularity because these nonirradiated bowel segments offer less risk for postoperative urinary leaks and small bowel complications associated with bowel and ureteral anastomoses. In 1978, Kock et al described the use of detubularized segments of ileum and the intussuscepted nipple valves to create a continent pouch that is still advocated by urologists in some centers. Ileocolonic continent pouches, originally suggested in 1908, have received considerable attention in the past 10 to 15 years because of ease of construction, lower revision rates, and higher continence rates compared with the Kock ileal pouches. At the Division of Gynecologic Oncology at the University of Miami, the authors have been using the Miami pouch as the preferred form of continent urinary diversion since 1988, with acceptable results. Women who need urinary diversion can be offered at least two major choices: (1) the traditional bowel (ileum or colon) conduit, which requires an external ostomy appliance, or (2) a continent pouch, such as the Miami ileocolonic reservoir. In choosing between non-continent and continent conduits, the patients must be made aware that the continent pouches are available in only a few centers in the United States and carry a slightly higher risk for complications because of the relatively higher complexity. Nonetheless, data strongly suggest that most of these complications can be managed noninvasively and that these patients retain a closer to normal quality of life. The age, disease status, and general health of the woman and the likelihood of her long-term survival after diversion weigh heavily in the final decision.
- Published
- 2001
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95. Low colorectal anastomosis after radical pelvic surgery: a risk factor analysis.
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Mirhashemi R, Averette HE, Estape R, Angioli R, Mahran R, Mendez L, Cantuaria G, and Penalver M
- Subjects
- Cohort Studies, Female, Humans, Retrospective Studies, Risk Factors, Anastomosis, Surgical, Colon surgery, Colonic Neoplasms surgery, Endometriosis surgery, Genital Neoplasms, Female surgery, Pelvic Exenteration, Rectum surgery
- Abstract
Objective: This study was conducted to analyze our experience with low (8-12 cm above the anal verge) and very low (<6 cm above the anal verge) colorectal resection and primary anastomosis at the time of radical en bloc resection of pelvic malignancies., Study Design: A retrospective review of 77 patients undergoing supralevator pelvic exenteration with low colorectal resection and primary anastomosis in our gynecologic oncology service was carried out. Data were obtained from patient medical records and from the tumor registry. Univariate statistical analysis of the data was used., Results: The distribution of primary malignancies in this cohort was as follows: 33 (43%) recurrent or primary cervical carcinomas, 27 (35%) primary or recurrent ovarian carcinomas, 7 (9%) recurrent vaginal carcinomas, 4 (5%) endometrial carcinomas, 3 (4%) colon carcinomas, and 3 (4%) cases of stage IV endometriosis. Forty patients underwent total pelvic exenteration, and 37 patients underwent posterior exenteration. Thirty-six patients in the total pelvic exenteration group had a history of pelvic irradiation. Twelve (30%) of these patients had development of breakdown or fistulas of the anastomosis. Six of the 12 patients (50%) had undergone protective colostomy. Thirty-seven patients underwent posterior exenteration with primary anastomosis for ovarian cancer, endometrial cancer, colon cancer, or endometriosis, and only 1 of these had received pelvic irradiation. This patient did not have a protective colostomy, and a rectovaginal fistula developed. In addition, there were 3 other breakdowns in the posterior exenteration group. Finally, the presence of preoperative ascites did not appear to alter the breakdown rate of the anastomosis among the patients with ovarian cancer who underwent cytoreductive surgery., Conclusion: Radical resection of pelvic tissue remains a crucial part of the armamentarium of the gynecologic oncologist. Previous pelvic irradiation appears to be a major risk factor (35% vs 7.5%) for anastomotic breakdown and fistulas, independent of the presence of a protective colostomy. The overall results appear to be better for patients undergoing this procedure as part of a posterior exenteration.
- Published
- 2000
- Full Text
- View/download PDF
96. Expression of GLUT-1 glucose transporter in borderline and malignant epithelial tumors of the ovary.
- Author
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Cantuaria G, Magalhaes A, Penalver M, Angioli R, Braunschweiger P, Gomez-Marin O, Kanhoush R, Gomez-Fernandez C, and Nadji M
- Subjects
- Cell Membrane metabolism, Epithelium metabolism, Epithelium pathology, Female, Glucose Transporter Type 1, Humans, Immunohistochemistry, Ovarian Neoplasms classification, Ovarian Neoplasms pathology, Ovary metabolism, Monosaccharide Transport Proteins biosynthesis, Ovarian Neoplasms metabolism
- Abstract
Objective: Cancer cells have increased rates of glucose metabolism when compared to normal cells. One of the mechanisms proposed for the accelerated glucose use in malignant cells is the overexpression of glucose transporters. In this study we evaluated the expression of the GLUT-1 glucose transporter in borderline and malignant epithelial neoplasms of the ovary., Methods: Histologic sections of tumor tissues from 21 borderline and 82 malignant epithelial neoplasms of the ovary were stained for GLUT-1 using polyclonal GLUT-1 antibody (Dako, Carpinteria, CA) and the labeled streptavidin biotin procedure. DAB was used as chromagen and tissues were counterstained with hematoxylin., Results: Normal ovarian surface epithelial cells were either negative or weakly positive. Of the 82 carcinomas, 81 (98.8%) were positive for GLUT-1. The staining intensity was significantly associated with the grade of tumor (P = 0.001). Of the 21 borderline neoplasms, 20 (95.2%) were positive for GLUT-1. Carcinomas had a significantly stronger stain than borderline tumors (P = 0.0001). The intensity of the stain was also stronger in serous carcinomas compared to other subtypes (P = 0. 0001). Positive cells demonstrated a cytoplasmic membrane staining that was more intense in tumor cells farther away from blood supply., Conclusion: Overexpression of the GLUT-1 transporter is associated with the histology and grade of the tumors. Our findings show a progressive increase in the expression of the GLUT-1 transporter from the borderline tumor to the high-grade carcinomas. These data suggest that the expression of this transporter may be closely related to the malignant transformation of epithelial ovarian tumors., (Copyright 2000 Academic Press.)
- Published
- 2000
- Full Text
- View/download PDF
97. Antitumor activity of a novel glyco-nitric oxide conjugate in ovarian carcinoma.
- Author
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Cantuaria G, Magalhaes A, Angioli R, Mendez L, Mirhashemi R, Wang J, Wang P, Penalver M, Averette H, and Braunschweiger P
- Subjects
- Drug Screening Assays, Antitumor, Female, Humans, Immunohistochemistry, Nitric Oxide chemistry, Nitric Oxide Donors chemistry, Penicillamine chemistry, Penicillamine pharmacology, S-Nitroso-N-Acetylpenicillamine, Tumor Cells, Cultured drug effects, Monosaccharide Transport Proteins biosynthesis, Nitric Oxide pharmacology, Nitric Oxide Donors pharmacology, Ovarian Neoplasms pathology, Penicillamine analogs & derivatives
- Abstract
Background: Several studies have shown that nitric oxide (NO)-releasing agents can kill tumor cells. Unfortunately, currently available NO delivery molecules do not target tumor cells preferentially. To exploit the overexpression of glucose transport proteins and the high level of glucose transport characteristics of tumor cells, glucose was conjugated to S-nitroso-N-acetyl-penicillamine (2-gluSNAP) and evaluated for cytotoxicity in human ovarian carcinoma cells., Methods: The cytotoxicity of 2-gluSNAP and SNAP was assessed by clonogenic cell survival assays performed in A2780S (cisplatin sensitive) and A2780cP (cisplatin-resistant) ovarian carcinoma cells in vitro. Immunoblotting and immunohistochemistry were used to assess the expression of Glut-1 hexose transport protein in the cell lines as well as in paraffin blocks from 28 surgical specimens of epithelial ovarian carcinoma. Apoptosis was assessed by an end-labeling assay., Results: The ovarian carcinoma cell lines consistently were more sensitive to 2-gluSNAP than SNAP alone. The median effective doses (MEDs) for 2-gluSNAP and SNAP in the A2780s cell line were 0.0042 microM and 20.4 microM, respectively. Therefore, 2-GluSNAP was nearly 5000-fold more potent than the NO-donating moiety (SNAP) alone. In the A2780cP cells, the MED for 2-gluSNAP (0.38 microM) was 250-fold lower than that for SNAP alone (100 microM). Immunoblotting and immunohistochemistry studies showed overexpression of Glut-1 in the cell lines and in 23 of 28 epithelial ovarian carcinoma specimens., Conclusions: The novel glyco-NO conjugate 2-gluSNAP exhibits a much greater cytotoxicity than the parent NO donor without the hexose moiety. These agents have the potential to target tumor cells preferentially, that overexpress Glut-1. This transporter is expressed highly in epithelial ovarian carcinoma., (Copyright 2000 American Cancer Society.)
- Published
- 2000
98. Primary uterine angiosarcoma.
- Author
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Mendez LE, Joy S, Angioli R, Estape R, and Penalver M
- Subjects
- Female, Humans, Middle Aged, Hemangiosarcoma pathology, Uterine Neoplasms pathology
- Abstract
Objective: The aim of this study was to report the first case of primary uterine angiosarcoma described in a Hispanic American woman and to review the literature on uterine angiosarcomas. We review characteristic presenting symptoms, gross and microscopic pathologic findings, and treatment outcomes where available., Methods: A case report is presented with a review of the English language literature via a Medline search. The key phrases used in the search were uterine angiosarcoma, hemangiosarcoma, hemangioendothelioma, and primary uterine neoplasm., Results: Since the first report in 1902, there have been 19 reported cases of primary uterine angiosarcoma considered valid. Many early cases are questioned due to the lack of ultrastructural and immunohistochemical evidence available in later cases. Seventy-four percent (14 of 19) of these patients are perimenopausal with a mean age of 55 years (range 17-76 years). The common presenting findings are a pelvic mass, menorrhagia, and weight loss. Varying regimens of surgery, chemotherapy, and radiation have been utilized with limited success., Conclusions: Primary uterine angiosarcomas tend to exhibit a highly malignant behavior. The predominant prognostic factor seems to be the size of the tumor at diagnosis and the presence of extrapelvic disease. Recurrence occurs on average at 8.2 months. Of evaluable patients (n = 14), at 12 months the survival was only 43%. Although radiation and chemotherapy are options being utilized, no consensus exists for optimal therapy given the few cases from which to draw conclusions. Regardless of treatment, outcome is usually poor., (Copyright 1999 Academic Press.)
- Published
- 1999
- Full Text
- View/download PDF
99. Primary malignant melanoma of the uterine cervix: case report and review of the literature.
- Author
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Cantuaria G, Angioli R, Nahmias J, Estape R, and Penalver M
- Subjects
- Aged, Female, Humans, Melanoma therapy, Uterine Neoplasms therapy
- Abstract
This is a case report and review of the literature on primary melanoma of the cervix. There have been only 26 published cases of primary cervical melanoma and most are poorly documented and doubtful. The patients' ages ranged from 26 to 78 years old with a mean age of 55 +/- 13 years. The main presenting symptom was vaginal bleeding (83.0%). The majority of the patients, 88%, presented in stage I or II. Treatment varied from a simple excision of a cervical mass to a radical hysterectomy with lymph node dissection and adjuvant radiation or chemotherapy. Our patient presented with vaginal bleeding and was diagnosed as having stage IIa cervical melanoma. She underwent a radical hysterectomy, partial vaginectomy, and pelvic and paraaortic lymph node dissection. She received adjuvant radiation therapy and her survival was 29 months. The prognosis of primary cervical melanoma is usually poor and unpredictable. We recommend a radical hysterectomy and vaginectomy, if necessary, to obtain negative surgical margins of at least 2 cm. We advocate lymphadenectomy only for grossly positive nodes., (Copyright 1999 Academic Press.)
- Published
- 1999
- Full Text
- View/download PDF
100. Evaluation of the Pfannenstiel incision for radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy.
- Author
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Mendez LE, Cantuaria G, Angioli R, Mirhashemi R, Gabriel C, Estape R, and Penalver M
- Abstract
Radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy (RAH/P + PAL) has classically been described through a low midline vertical incision. Transverse incisions have been used with good results for various pelvic surgical procedures. Hesitancy has been encountered when utilizing these transverse incisions in gynecologic oncology patients. In most studies, muscle-splitting transverse incisions seem to be of equal efficacy as midline vertical incisions in regards to surgical exposure and clinicopathologic data obtained and are known to be superior in cosmesis and postoperative morbidity. A retrospective chart review was performed to identify 25 patients who underwent RAH/P + PAL for stage I carcinoma of the cervix from 1990 to 1998 through a nonmuscle splitting (Pfannenstiel) abdominal incision. All patients were seen and had follow-up in the Division of Gynecologic Oncology, University of Miami School of Medicine/Jackson Memorial Medical Center (Miami, FL). Data were collected on various clinical and surgical parameters including height/weight, operative time, blood loss, number of lymph nodes obtained, length of hospital stay, and postoperative complications. Analysis of the data revealed that operative time and average blood loss were within acceptable parameters. The yield at lymphadenectomy for pelvic and para-aortic lymph nodes was also respectable. Postoperative complications were minimal and there were no wound complications reported. Therefore, the Pfannenstiel incision can be safely utilized in a select group of patients undergoing RAH/P + PAL.
- Published
- 1999
- Full Text
- View/download PDF
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