Bernd Uwe Sevin

Psychoneuroimmunological aspects of disease progression among women with human papillomavirus-associated cervical dysplasia and human immunodeficiency virus type 1 co-infection.

Objective: Psychosocial associations have been observed with level of cervical dysplasia or “pre-cancer” and invasive cervical cancer [related to human papillomavirus (HPV) infection]. Psychoneuroimmunological relationships have been observed in human immunodeficiency virus type 1 (HIV-1) infection, which is being described in an increasing number of women. Our objective was to review these relationships regarding effects that might be expected in HIV-1 and HPV co-infected women. Method: This review was based on a Medline literature search supplemented by a manual search of selected journals unrepresented in that database. Results: Relationships of psychosocial factors and level of cervical dysplasia were similarly observed with reference to immunological and health status in asymptomatic and early symptomatic HIV-1 infected homosexual men, suggesting that a potentiating effect may occur in HIV-1 and HPV co-infected women. Consistency of relationships across studies appeared to be enhanced by the use of a biopsychosocial model integrating the effects of life stressors, social support and coping style as well as psychiatric disorders. Conclusions: Research is indicated on the relationships between psychosocial factors, immunological status and clinical health status in this group of women. Because of the high prevalence of psychosocial risk factors for chronic psychological distress in these women and the known immunological and health status decrements occurring with progression of these two infections, a clinical screening program based on the biopsychosocial model is recommended as a means of secondary prevention. If effective in generating treatment referrals, such a program would likely improve quality of life and could aid in the determination of relationships with immunological and health status as well.

Amonafide in patients with leiomyosarcoma of the uterus: A phase II gynecologic oncology group study

Twenty-six evaluable patients who had leiomyosarcoma of the uterus were treated with amonafide, 300 mg/m2, for 5 consecutive days every 3 weeks. One partial response (4%) resulted. Hematologic toxicity was substantial, with grade 3 or 4 events occurring as follows: leukopenia, 12 patients (46%); thrombocytopenia, 4 patients (15%); and granulocytopenia, 7 patients (27%). One patient had transient grade 4 renal failure. Considering the poor activity and substantial toxicity that was observed, no further studies are planned by the Gynecologic Oncology Group using amonafide at this dose schedule in leiomyosarcomas.

The role of radioimmunoscintigraphy and computed tomography scan prior to reassessment laparotomy of patients with ovarian carcinoma: A preliminary report

Accurate evaluation of patients with ovarian carcinoma who have completed primary therapy often requires surgical exploration. Radioimmunoscintigraphy (RIS) represents an evolving technique that may allow noninvasive detection and localization of persistent or recurrent disease in these patients.

Danazol relieves refractory pruritus associated with myeloproliferative disorders and other diseases

Severe pruritus is frequently associated with myeloproliferative and other systemic illnesses, and often fails to respond to conventional measures. We used danazol (Danocrine™), a synthetic attenuated androgen, in the treatment of severe pruritus refractory to conventional therapy. Eight patients had myeloproliferative disorders (MPD), seven had autoimmune disorders, and seven had skin diseases. Danazol at 400–800 mg/day was administered, and previous medications were tapered off. When itching was controlled with danazol alone, the dosage was reduced or discontinued, and resumed if itching recurred. Clinical responses were graded, and side effects were monitored. Overall, in 12 of 22 patients refractory to other measures, itching was controlled with danazol alone. In 10 patients itching returned when danazol was discontinued or dosage was reduced, and was relieved upon resumption or increase of dosage. Danazol therapy was continued for up to 5 years in responders. No serious side effects were observed. Our experience indicates that danazol is a good alternative for patients with severe pruritus associated with myeloproliferative and other systemic disorders.

In vivo chemosensitivity testing in patients with gynecologic malignancies and nude mouse xenografts by monitoring cell kinetic parameters and DNA distribution patterns: A preliminary report

Using flow cytometry (FCM) and autoradiography we have evaluated changes in DNA-ploidy patterns as well as cell-cycle perturbations after chemotherapy in 12 patients with accessible tumors and 22 nude mice xenografts. Gynecologic malignancies growing as nude mouse xenografts serve as an experimental model to study the effect of chemotherapy at the cellular level. Excellent correlation was found between fine needle aspiration (FNA) and biopsy material for either FCM or autoradiography. It now appears possible to study the effects of chemotherapy in the patient as well as the animal model using serial FNAs as a microsampling technique.

Fine-needle-aspiration cytology in gynecologic oncology: “Early detection of occult persistent, or recurrent cancer after radiation therapy”☆

Abstract This study discusses the value of fine-needle-aspiration cytology in the early detection of occult carcinoma in patients treated with radiation therapy for gynecologic malignancies. Fifty-eight patients with normal cervical cytology were evaluated with 77 fine-needle aspirations (FNA) starting as early as 3 months after therapy. The results of FNAs added about 30% predictability to the accuracy of diagnosing carcinoma to that of the conventional methods used today like pelvic examination and radiographic studies. Fine-needle aspiration of the pelvis after radiation therapy is an accurate and safe method to sample the parametria, pelvic sidewalls, and other sites of possible recurrence, and may be used as part of the routine follow-up of these patients.

Fine needle aspiration cytology of supraclavicular lymph nodes in gynecologic malignancies

Abstract Eight cases of fine needle aspiration (FNA) of supraclavicular lymph nodes are presented. Clinical and pathologic data and the route of spread to the left supraclavicular node (Vir-chows node) are discussed. FNA has proven to be an accurate, inexpensive, and easily learned skill in the evaluation of distant metastatic disease. Careful palpation of the supraclavicular nodes in all patients with known or suspected pelvic malignancy may influence stage and therapy if positive nodes are identified.