Jean Claude Remy

Human immunodeficiency virus infection and cervical neoplasia

To determine the relationship between human immunodeficiency virus (HIV) infection and cervical neoplasia, the characteristics of invasive and preinvasive cervical disease in 114 patients of known HIV status were assessed. Seven of thirty-seven patients (19%) under age 50 with invasive cervical carcinoma were HIV-positive, including a 16-year-old with stage IIIB disease. HIV-positive patients had more advanced invasive cancer than HIV-negative patients. Disease persisted or recurred in all HIV-positive patients compared to 37% of HIV-negative patients. In HIV-positive patients, the median times to recurrence and death were 1 and 10 months, respectively. No HIV-positive patient had HIV-related symptoms. The mean T4:T8 cell ratio in HIV-positive patients was 0.49, compared to 1.86 in HIV-negative patients. The mean T4 cell count was 362/mm3 in HIV-positive and 775/mm3 in HIV-negative patients. Colposcopic evaluations of the lower genital tract of 77 patients with abnormal smears revealed higher-grade cytology and histology in 25 HIV-positive than in 52 HIV-negative patients. HIV-positive patients had significantly more multifocal/extensive lesions, multisite involvement, perianal involvement, evidence of human papillomavirus (HPV) infection, and associated gynecologic infections than HIV-negative patients. In areas at high risk for HIV infection, we must anticipate a high prevalence of HIV seropositivity in women with invasive cervical cancer. In the HIV-infected, cervical cancer is of advanced stage and responds poorly to therapy. Intraepithelial neoplasia in HIV-positive patients may be of higher grade than in HIV-negative patients, with more extensive involvement of the lower genital tract.

Screening for cervical and breast cancer among Caribbean immigrants

A screening program for cervical and breast cancer, focused on immigrant Caribbean women, was carried out at neighborhood sites (churches, schools, etc.) in a low-income area of Brooklyn, New York.The yield of abnormal Pap tests was 13.3/1000 women screened; the yield of breast cancer was 2.2/1000 women examined. Approximately half of the Haitian immigrants (N=361) had no prior Pap test, compared to one-quarter of the English-speaking Caribbean immigrants (N=228) and one-tenth of the U.S.-born Black women (N=264). Only 47% of Haitian women had a regular source of health care compared to 74% of the English speaking Caribbean women and 83% of the U.S.-born Black women. Haitian women were much less likely to practice breast self-examination or to use contraception than were U.S.-born Black women.This program reveals significant needs for preventive health services among low-income Caribbean immigrant women, and demonstrates that selective neighborhood-site programs can be effective in reaching those in need.

Cervix and breast cancer incidence in immigrant Caribbean women.

Cervix and breast cancer incidence in 1978-82 was computed for immigrant and United States-born Black women in Brooklyn, New York. Compared to the national SEER (Surveillance, Epidemiology and End Results) rates, US-born and Haitian women had high rates of invasive cervical cancer, while English-speaking Caribbean immigrants had an average rate. However, while US-born women had an average rate of carcinoma in situ of the cervix, both immigrant groups had low rates. Both immigrant groups had low rates of breast cancer, whereas US-born Black women had an average rate.

Adjunctive radiation after radical hysterectomy in stage IB squamous cell carcinoma of the cervix

The clinical-pathologic records of 178 women with stage IB squamous cell carcinoma treated by radical hysterectomy and pelvic node dissection were reviewed to assess prognostic factors and outcome in relation to adjunctive pelvic radiation. Among 32 women with pelvic nodes metastases, 19 treated with adjunctive radiation had longer recurrence-free intervals and more extrapelvic metastases than 13 nonirradiated women. However, among irradiated women recurrences were more rapidly fatal, so that the survival of the two groups was similar. Among 54 women with deeply invading (10 mm or more) carcinomas confined to the uterus, 17 with adjunctive radiation had recurrence-free intervals and survivals similar to 37 women without radiation, despite more high-risk factors in the irradiated group. The findings suggest that adjunctive pelvic radiation may control pelvic recurrence but not extend survival.

Cervical cancer in immigrant Caribbean women.

At a public hospital serving the low-income community in Brooklyn, New York, invasive cervical cancer (ICC) was diagnosed in more advanced stages in Haitian and English-speaking Caribbean immigrants than in US-born Black women. In Brooklyn as a whole, only Haitians had more advanced ICC. Fewer Haitians had preinvasive cancer or ICC detected by a Pap test. Data are consistent with less frequent screening among low-income immigrants.

Stented versus nonstented transverse colon conduits: A comparative report

Postoperative urinary tract complications were evaluated in 75 women who underwent urinary diversion with formation of a transverse colon conduit after radiation for gynecologic cancer. Urinary stents were placed at the ureterocolonic junction in 37 women, while no stents were used in 38 women. Leaks or fistulae developed in 18% of the nonstented group but in only 3% of the stented group (P less than 0.05). Ureteral strictures developed in 18% of the nonstented but in only 8% of the stented group. Pyelonephritis developed in 13% of the nonstented and in 8% of the stented patients. Overall, urinary tract complications developed in 50% of the nonstented and in 16% of the stented group (P less than 0.01). Leaks or strictures developed in 11% of the 75 renal units in the nonstented group but in only 1% of the 72 renal units in the stented group (P less than 0.02). Postoperative leaks or fistulae were associated with further serious complications. Results indicate a significant advantage in employing stents at the ureterocolonic junction in the formation of a transverse colon conduit.

Uterine rupture secondary to a malignant mixed mesodermal (mullerian) tumor: a case report.

A case of uterine rupture resulting from tumor penetration of the myometrium in a patient with malignant mixed mesodermal tumor is described; the first in the literature known to the authors. Notable features include rapid progression of disease, hemoperitoneum, and diffuse intraoperative bleeding controlled by radiographic embolization.