泌尿生殖道感染患者淋病奈瑟菌、沙眼衣原体和解脲脲原体感染临床分析

目的了解泌尿生殖道感染患者淋病奈瑟菌（NG）、沙眼衣原体（CT）和解脲脲原体（UU）的感染现状及其特点。方法应用实时荧光聚合酶链反应（PCR）检测630例（男性274例,女性356例）泌尿生殖道感染患者泌尿生殖道分泌物的NG、CT和UU核酸,并对其中108例患者行单纯疱疹病毒（HSV）检测,82例行人乳头瘤病毒（HPV6/11/16/18）检测。结果在630例患者中,NG、CT和UU的阳性检出率分别为3.2%（20/630）、9.8%（62/630）和47.1%（297/630）,HSV的阳性检出率为2.8%（3/108）,HPV6/11/16/18的阳性检出率为8.7%（8/92）,其中男性NG、CT和UU的阳性检出率分别为5.1%（14/274）、10.9%（30/274）和21.5%（59/274）,女性分别为1.7%（6/356）、9.0%（32/356）和66.9%（238/356）,女性UU阳性检出率明显高于男性（P〈0.01）,男性NG阳性检出率明显高于女性（P〈0.05）;男性和女性患者中,NG阳性检出率均以〈30岁组（7.4%,7/94;3.5%,4/115）较高,男性CT阳性检出率以〉40岁组（17.5%,7/40）最高,女性以〈30岁组（17.3%,18/104）最高,UU在不同性别各年龄组比较,差异均无统计学意义（P〉0.05）;CT＋UU双重感染的阳性检出率最高,为8.2%（31/379）,NG＋UU＋CT双重感染检出率为1.6%（6/379）,HPV 6/11＋NG、HPV 6/11＋CT混合感染各1例,HSV-Ⅰ/Ⅱ伴UU感染2例。结论泌尿生殖道感染患者NG、CT和UU阳性检出率不尽相同,其中以UU最高,且女性阳性检出率高于男性,两种及以上病原体混合感染较为常见,临床应注意进行多种病原体的检测。     

Second look laparoscopy; evaluation of two different antibiotic regimens after treatment of acute salpingitis

In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken. The patients were referred to groups of either a mild (16/64), a moderate (26/64), or a severe (22/64) form of salpingitis. They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated by second-look laparoscopy 3–6 months later when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36/64 (56%) (9/16 with a mild form, 13/26 with moderate form and 14/22 with a severe form of salpingitis). Neisseria gonorrhoeae (NG) was isolated from the cervix in 15/64 (23%) (5/16 with a mild form, 4/26 with a moderate form and 6/22 with a severe form of the disease). Oviductal cultures for CT were found in 12/64 (19%) (1/16 with a mild form, 4/26 with a moderate and 7/25 with severe form of salpingitis). Oviductal isolates for NG were found in 2/64 (13%) (2/16 from the group with a mild form of the disease). Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).     

子宫颈淋球菌解脲支原体人型支原体和沙眼衣原体感染1866例分析

目的：探讨子宫颈淋球菌（NG）,解脲支原体（UU）,人型支原体（MH）和沙眼衣原体（CT）感染情况。方法：应用病原体培养及免疫荧光检测等方法,对我科性病专科门诊初诊的1866例女性患者,取宫颈拭子进行NG,UU,MH和CT四种主要性传播疾病（STD）病原体检测。结果：病原体检出率分别为NG 3．16％（59／1866）,UU49．62％（926／1866）,MH 11．58％（216／1866）和CT17．58％（328／1866）,总的病原体检出率为60．29％（1125／1866）,其中单一病原体感染率为41．00％（765／1866）,混合感染率为19．29％（360／1866）,结论：UU,CT,MH和NG是宫颈感染的主要病原体,其感染率UU＞CT＞MH＞NG,且混感染已是一个越来越严重的问题。     

正常孕妇复合感染后妊娠结局的研究

目的 :探讨正常孕妇复合感染后对妊娠结局的影响并拟定初筛感染原方案。方法 :收集在本院分娩的 2 16例、2 16例正常头位初产妇初诊时的宫颈分泌物。每份标本都采用 3种聚合酶链反应 (PCR)同步检测 9种较常见的感染原 :人型支原体 (MH)、疱疹病毒 1、2型 (HSV- 1、2 )和人乳头瘤病毒 (HPV)应用 1次 PCR;解脲支原体 (U U)、沙眼衣原体(CT)及巨细胞病毒 (CMV)使用套式 PCR;淋球菌 (NG)与弓形体 (TOXO)采用两个基因区 PCR。结果 :1除外 7例因其他因素引起的不良妊娠结局者 ,复合感染率为 9.1% (19/ 2 0 9) ;占总感染数 2 0 .9% (19/ 91)。 2 19例复合感染中除 1例外 ,均感染支原体 ;3例死胎、畸胎均由复合感染疱疹科病毒孕妇所娩 ,其中 1例死胎脑组织检出 CMV- DNA。 3复合感染者之胎儿窘迫、剖宫产和死胎、畸胎率均明显高于未受染者 (P<0 .0 5～ 0 .0 1) ;而单一受染者则未发生死胎、畸胎。结论 :产前 ,最好在孕前 ,正常孕妇也应常规筛查至少两类疱疹科病毒 :CMV和 HSV- 2     

女性下生殖道沙眼衣原体及解脲支原体感染与输卵管妊娠的相关性

目的探讨女性下生殖道沙眼衣原体(CT)、解脲支原体(UU)感染与输卵管妊娠发生的关系以及夫妻双方接受敏感抗生素治疗CT、UU感染的输卵管妊娠患者术后输卵管通畅情况。方法 (1)对暨南大学附属第一医院2009年9月至2011年9月135例手术治疗的输卵管妊娠患者(研究组)和68例卵巢囊肿、子宫肌瘤患者(对照组)宫颈分泌物行性传播疾病病原体检测和药敏试验。(2)对有生育要求的65例CT、UU阳性的输卵管妊娠患者根据治疗情况分成夫妻双方同时接受敏感抗生素治疗的治疗组35例和预防性使用抗生素治疗的预防组30例,两组患者在手术当天均预防性使用抗生素,前者再根据药敏试验结果选择敏感抗生素对夫妻双方进行规范治疗,后者手术24h后不再使用抗生素。3个月后行子宫输卵管碘油造影(HSG),检查输卵管通畅情况。结果 (1)研究组CT、UU、CT+UU混合感染、淋病奈瑟菌(NG)检出率分别为19.3%(26/135)、40.7%(55/135)、8.9%(12/135)、3.7%(5/135);对照组CT、UU、CT+UU混合感染、NG的检出率分别为4.4%(3/68)、17.6%(12/68)、0(0/68)、、0(0/68)。两组CT、UU、CT+UU混合感染检出率差异有统计学意义(均P<0.05)。(2)HSG显示敏感抗生素治疗组患者患侧输卵管通畅31例(88.6%),阻塞或通而不畅4例(11.4%);预防性抗生素使用组患者患侧输卵管通畅20例(66.7%),阻塞或通而不畅10例(33.3%)。两组差异有统计学意义(均P<0.05)。结论以CT和UU为主的性传播病原体感染与输卵管妊娠的发生有关;根据药敏试验结果对CT和UU阳性的夫妻加强治疗,可能有助于提高术后3个月的输卵管复通率及减少输卵管妊娠的再发。     

The prevalence of ureaplasma urealyticum,mycoplasma hominis,chlamydia trachomatis and neisseria gonorrhoeae infections,and the rubella status of patients undergoing an initial infertility evaluation

Purpose To determine the prevalence of positive test for Ureaplasma urealyticum (UU), Mycoplasma hominis (MH), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) infections, and their corresponding Rubella status when undergoing workup for infertility. Methods Retrospective chart review to determine infection status for UU, MH, CT, and NG as determined by cervical swab, as well as the serum Rubella antibody titer. Results A total of 46 patients of the patients reviewed were positive for UU (20.1%), three patients were positive for MH (1.3%), five patients were positive for CT (2.2%) and one patient was positive for NG (0.4%). Rubella immunity was confirmed in 90.3% of patients. Conclusion Approximately one quarter of women presenting to an infertility clinic seeking to conceive were found to have a positive test for UU, MH, CT or NG infection. Additionally, almost 10% of the patients were Rubella non-immune at the time of presentation for infertility evaluation. Determination of ureaplasma, mycoplasma, chlamydia and gonorrheae infections as well as rubella status in patients undergoing infertility treatment is important during the initial evaluation.     

PTEN和P27在子宫内膜腺癌中的表达

目的　探讨与张力蛋白同源的第 1 0染色体丢失的磷酸酶基因 (PTEN)与细胞周期调控因子P2 7在子宫内膜腺癌发生发展中的作用 ,并通过对PTEN与P2 7关系的研究 ,分析PTEN功能异常参与癌发生的分子机制。方法　应用免疫组织化学SP法 ,检测了 1 2例增生期子宫内膜 ,4 2例子宫内膜增殖症包括 1 5例单纯型增生 (SH) ,1 9例复合型增生 (CH)和 8例非典型增生 (AH) ,4 5例子宫内膜腺癌组织中PTEN和P2 7的表达情况。结果　在增生期子宫内膜、子宫内膜增殖症和子宫内膜腺癌中PTEN阳性表达率呈下降趋势 ,分别为 91 7%(1 1 / 1 2 )、 4 2 9% (1 8/ 4 2 )和 37 8% (1 7/ 4 5 ) ,增生子宫内膜PTEN阳性表达率显著高于子宫内膜增殖症和子宫内膜腺癌 (P <0 0 0 1 ) ,PTEN在SH中的阳性表达率为 73 3% (1 1 / 1 5 ) ,高于在CH和AH的阳性表达率 ,分别为2 6 3% (5 / 1 9)和 2 5 0 % (2 / 8) (P <0 0 0 5 )。P2 7在增生子宫内膜、子宫内膜增殖症和子宫内膜腺癌中的阳性表达率分别为 1 0 0 0 % (1 2 / 1 2 )、 6 4 3% (2 7/ 4 2 )和 4 2 2 % (1 9/ 4 5 ) ,三者比较 ,差异有显著性 (P <0 0 5 )。P2 7在SH ,CH和AH中的阳性表达率分别为 80 0 % (1 2 / 1 5 ) ,6 8 4 % (1 3/ 1 9)和 2 5 0 % (2 / 8)。SH和CH中P2 7的阳性     

The incidence and management of failed Pipelle sampling in a general outpatient clinic

A prospective audit was performed on 100 consecutive patients who underwent Pipelle endometrial sampling in a general outpatient clinic setting. The indications for sampling were abnormal menstrual bleeding (AMB, 65), intermenstrual or postcoital bleeding (IMB/PCB, 7), postmenopausal bleeding (PMB, 28). An insufficient sample was obtained in 33 women: (AMB 14, 21.5%); IMB/PCB, (0); PMB 19,68%). In 3 women the Pipelle was unable to be introduced through the cervix; in the remainder an insufficient sample for histological diagnosis was obtained. Registrars and resident doctors were more likely to sample insufficiently. In the AMB group all but 1 woman with an insufficient sample had further investigations or treatment but 7 of 19 (37%) of PMB patients had no further investigations. Where definitive histology was available, endometrial polyps or submucous fibroids were found in half of the cases with an inadequate Pipelle sample. Pipelle sampling detected only 1 of the 2 cases of endometrial cancer in this study.     

The diagnostic value of PET/CT scanning in patients with cervical cancer: a prospective study

OBJECTIVE: To investigate the clinical value of PET/CT as a supplement to FIGO staging in patients with cervical cancer stage >or=1B. METHODS: This prospective study included 120 consecutive patients. After staging, a whole-body PET/CT scan was performed and these examinations were divided into two groups: (1) patients suitable for radical hysterectomy including lymph node dissection and (2) patients referred to combined chemo/radiation therapy. The results were compared to histopathological findings and/ or follow-up. RESULTS: Twenty-seven patients underwent radical surgery; four of these had PET/CT scans revealing pathological foci in the pelvis. Three (11%) were true positive; one was false positive. Twenty-two patients had true negative PET/CT scans concerning pelvic lymph nodes. One patient had a false negative node. For these patients, we found the positive predictive value (PPV) to be 75%, negative predictive value (NPV) 96%, sensitivity 75%, specificity 96%. Regarding para-aortal nodal disease in the total population of 119 patients, 15 patients had true positive scans. The number of true negatives was 103, resulting in PPV 94%, NPV 100%, sensitivity 100% and specificity 99%. PET/CT scans showed distant metastases in 19 patients, 10 were true positive and nine were false positive. The remaining 100 patients were considered true negative for distant metastases and for these patients, we found PPV 63%, NPV 100%, sensitivity 100% and specificity 94%. CONCLUSIONS: Whole-body FDG PET/CT scanning for newly diagnosed cervical cancer FIGO stage >or=1B has a high sensitivity and specificity, and can be a valuable supplement to the FIGO staging procedure.     

Chlamydia trachomatis infection in the female patients

With recent advances in the development of detection methods, the number of STD (Sex transmitted disease) cases detected is greater than ever. Among many STD, Chlamydia trachomatis (= CT), a microbe that has been given a great deal of attention in the urologic field as a cause of nonspecific urethritis and has a characteristic life cycle, has been gradually proved to exist commonly and to become a cause of various obstetrical and gynecological diseases. However, as it is clinically still unknown which symptoms are actually influenced by CT, we studied infection with CT in 706 cases, consists of a group of patients with some symptoms and an asymptomatic group mainly consisting of pregnant women. As a result, the positive rate was found to be 12.3% (87 cases); 10.8% (21 out of 194) in asymptomatic pregnant women, 11.0% (13 out of 118) in patients with cervicitis, and 14.9% (30 out of 202) in patients with adnexitis including PID. As to age, the positive rate was highest, 23.1%, in patients under 20 years old. In fact, 1) CT positive pregnant women are not rare, and 2) CT was detected in high frequency in the young generation under 20 years old; and in these young women, the possibility of transmission of the disease to the infant in the birth canal should be considered in connection with future pregnancy and delivery. Tubal sterility may also result. We concluded that it was necessary to establish a satisfactory examination system.     

Immunohistochemical demonstration of carcinoembryonic antigen and ultrastructural features of endometrial adenocarcinoma

Determination of carcinoembryonic antigen levels in plasma (45 cases) and the immunohistochemical demonstration of tumor CEA (37 cases) were carried out in patients with endometrial adenocarcinoma. Twenty four out of 37 were also studied with the electron microscope. The plasma CEA level prior to therapy was significantly elevated (greater than 5.0ng/ml) in only one case (1/45:2.2%) of endometrial adenocarcinoma. CEA levels were more consistently elevated (4/17:23.5%) in patients with cervical adenocarcinoma. Immunoperoxidase staining of CEA (PAP method) was carried out using formalin-fixed paraffin embedded sections of 37 tumors. Tissue CEA activities were found in 9 out of 37 endometrial adenocarcinomas (24.3%) and 19 of 23 cervical adenocarcinomas (82.6%). Immunoreactive CEA was present in a high concentration on the cell surface of endometrial glands and less dense in their cytoplasm. In 9 of CEA positive endometrial carcinoma tissues, squamous metaplastic lesions were found in 4 cases and mucinous metaplasia in one case which were all CEA positive. With regard to the histopathological grade, CEA positive specimens were categorized G1 (4) and G2 (5) and all of the G3 were CEA negative. Seven of 9 cases of CEA positive specimens were examined under the electron microscope. There was no definite tendency in their ultrastructural characteristics, but all of the specimens examined revealed abundant cytoplasmic organelles suggestive of intracytoplasmic differentiation analogous to those of endometrial cells in proliferative phase. Moreover, fine structures of squamous and mucinous metaplastic cells were also described in detail.     

Fecundity and morbidity following acute pelvic inflammatory disease treated with doxycycline and metronidazole

We studied fecundity and late sequelae of 39 women who had laparoscopic and microbiological sampling-proven acute pelvic inflammatory disease (PID) treated with the same antimicrobial regimen. The grade and etiology of index PID were classified using laparoscopy, endometrial biopsy and microbiological cultures from the cervix, endometrium and tubes: 20 had mild and 19 severe PID. The mean (SD) follow-up period after the index PID was 125 (44) [range 8–204] months. The primary end-point was pregnancy. All other or recurrent infections or other diseases related to the infection, including infertility, were evaluated. Twenty (51%) women had laparotomy or second laparoscopy during follow-up and findings were evaluated. Chlamydia trachomatis was isolated in 38% of all cases. Eleven (28%) of 39 women avoided conception or it was no longer possible. Twenty-eight women had tried to conceive after the index PID and 25 (89%) of them had at least one pregnancy. Twenty-five women had 56 pregnancies, 33 (59%) of which ended in delivery, 9 (16%) miscarried, 13 (23%) were induced abortion and only one (1.8%) tubal pregnancy occurred. Etiologic factors or severity of PID made no difference to the conception rate. Patients with mild or moderate salpingitis had a high conception rate. Endometriosis was found in 6 (30%) out of 20 women with second laparoscopy or laparotomy. Hysterectomy had been performed in 4 cases. Precise diagnosis of acute PID is the cornerstone for the treatment of the condition. Combination regimens, including drugs against the most common factors underlying acute PID against both aerobic and anaerobic microbes, prevent late sequelae in cases with mild or moderate salpingitis but not in cases with tubal or pelvic abscess.     

Influence of chlamydial infection on fallopian tubes and its relation to cervical antigen and serum antibodies

Relation between chlamydial infection and oviductal changes and their screening method were studied by laparoscopic findings obtained from cases (group A; positive intracervical antigen detected by Chlamydiazyme) and from other cases (group B; negative antigen, but positive IgG antibodies detected by micro-immunofluorescence, MIF). Group A consisted of 8 cases/15 tubes, and group B of 20 cases/40 tubes. These two groups were called infection groups, and there was a control group of 14 cases/28 tubes with negative results for both tests. (1) No significantly different incidence was noted between groups A and B for perifimbrial (PFA) and peritubal (PTA) adhesions and tubal occlusions (TO). (2) The control group had significantly lower incidences for the number of tubes with PFA or TO than the infection group. (3) Even in 20 cases without an alleged history of PID (pelvic inflammatory disease), 15 cases belonged to group B. It was concluded that chlamydial infection may cause latent tubal lesions and a chlamydial antibody study should be involved in predicting them, because it would detect an unignorable number of pathologic cases which would have probably been missed if cervical antigen test and/or alleged PID history were the only screening procedures used.     

Pervaginal cul-de-sac cytology and CT in the follow-up care of patients with advanced ovarian cancer

Among 28 patients with advanced ovarian cancer (FIGO stage III) treated with cytotoxic chemotherapy there were 23 cases with residual malignant disease as revealed by "second-look" surgery. Preoperative studies including fine needle cul-de-sac washing samples (FD) for cytology and abdominopelvic computed tomography (CT) detected 13 tumors with residual disease. No false positive findings were encountered among preoperative studies. There were 2 cases in which both clinical examination and CT detected malignant growth. In 2 cases clinical examination revealed tumors not detected by CT. On the other hand in 3 cases CT found the residual disease. In 6 cases residual tumors were preoperatively detected only by FD cytology. Manually and radiologically undetectable tumors were greater than 1 cm in diameter in 7 cases, fine nodular involvements in 8 cases, and in 1 case the residual disease was only cytologically diagnosed.     

Clinical use of CA 125 and its combination assay with other tumor marker in patients with ovarian carcinoma

The serum levels of CA 125 and CA 19-9 were determined by an immunoradiometric assay employing the monoclonal antibody OC 125 and anti-CA 19-9 antibody in 88 patients with ovarian carcinoma. When a cut-off value of CA 125 was set below 35 U/ml in the control group, serum elevated levels of CA 125 were found in 86.7% of the patients with surgically demonstrable ovarian serous cystadenocarcinoma, in 100% (4/4 cases) of clear-cell carcinoma, in 50% (2/4 cases) of endometrioid carcinoma, in 100% (5/5 cases) of undifferentiated carcinoma, and in 80% of the recurrent cases. Using a cut-off value of 37 U/ml, serum elevated levels of CA 19-9 were detected in 68.2% of mucinous cystadenocarcinoma, in 28.9% of serous cystadenocarcinoma, in 75% (3/4 cases) of metastatic ovarian carcinoma, and in 37.5% of the recurrent cases. A statistical analysis of the combination assay using CA 125, CA 19-9, tissue polypeptide antigen (TPA), immunosuppressive acidic protein (IAP), ferritin and CEA was carried out by multivariate method (discriminatory analysis) in 45 patients with ovarian carcinoma and 50 healthy subjects. As a result before treatment, positive rates of a single tumor marker were 79.7% with CA 125, 42.7% with CA-19-9, 73.1% with IAP, 61.7% with TPA, 64.3% with ferritin and 25.4% with CEA, respectively. A combination assay of these markers was useful for detecting identification of ovarian carcinoma, by which it gave a higher accuracy of ovarian cancer detection.     

Screening females for chlamydia trachomatis (CT) In a large managed care organization (Mco). A new hedis measure

Background: Since CT testing for females is a new Health Plan Employer Data and Information Set (HEDIS) measure to assess MCO quality of care, we determined the proportion of females enrolled in a large closed panel vertically integrated MCO serving a demographically diverse population who were tested for CT at least once during 1998 and resulting CT prevalences.Methods: A data base with MCO members >/= 12 yrs old tested with CT DNA probes (GenProbe) from 1/1/98-12/30/98 was examined. Only females 12-24 yrs old and enrolled at least 11 continuous months in 1998 were included in the analysis.Results: In 1998, 5425 (13.1%) of 41,566 females 12-24 yrs were CT tested and 849 (2.0%) tested positive at least once. Proportion of females tested and proportion of females testing positive at least once varied by age and clinic location. Among 11, 562 12-14 yr females, 277 (2.4%) were CT tested and 48 (0.4%) tested positive; among 18,155 15-19 yr females, 2,424 (13.4%) were tested and 572 (3.2%) tested positive; and among 11,849 20-24 yr females, 2, 724 (23.0%) were tested and 229 (1.9%) tested positive. The proportion 12-24 yr females tested was 579/3,945 (14.7%) with 92/3, 945 (2.3%) testing positive in the Baltimore area; in Washington, DC/Maryland area 2,999/21,085 (14.2%) were tested with 601/21,085 (2. 9%) testing positive; in Northern Virginia 1,847/16,536 (11.2%) were tested with 156/16,536 (0.9%) testing positive.Proportion of females with at least one positive test among those females who were tested for CT also varied by age and clinic location. Among 277 of 12-14 yr females tested 48 (17.3%) tested positive at least once; among 2,424 of 15-19 yr females tested, 572 (23.6%) tested positive at least once; and among 2,724 of 20-24 yr females tested, 229 (8.4%) tested positive at least once. The proportion of females tested with at least one positive test among 12-24 yr females was 92/579 (15.9%) in the Baltimore area, 601/2,999 (20.0%) in Washington DC/Maryland area, and 156/1,847 (8.4%) in Northern Virginia.Conclusion: CT testing of adolescent females 12-19 yrs revealed a high proportion of positive tests. The lower proportion of positive tests in young adults 20-24 yrs may be due to differences in prevalence and increased number of tests performed. CT testing practices and rates varied by location. Therefore, in a large MCO, a uniform system wide approach in identifying and screening sexually active adolescent females may identify a large reservoir or asymptomatic infection.     

性传播疾病病原体在急性盆腔炎发病中的作用

目的 研究性传播疾病病原体在急性盆腔炎发病中的作用。方法 对130例急性盆腔炎患者的宫颈分泌物采用分离培养法进行细菌培养及性传播疾病系列检查。结果 130例急性盆腔炎患者中,有55例培养出性传播疾病病原体,其中淋病奈瑟菌检出率为6．9％（9／130）,约半数病例混有解脲支原体、沙眼衣原体及白色念珠菌感染;沙眼衣原体检出率为4．6％（6／130）,均为混合感染（淋病奈瑟菌、解脲支原体及厌氧菌）;解脲支原体检出率为37．7％（49／130）,三分之一病例存在混合感染。结论 性传播疾病病原体可为急性盆腔炎的发病因素,但也可能仅在急性盆腔炎发病中起协同作用。     

In situ hybridization for human papillomavirus as a method of predicting the evolution of cervical intraepithelial neoplasia

Summary Twenty-four women with cervical condylomata which were immunohistochemically positive for human papillomavirus (PV-Ag) (15 with CIN1 and 9 with CIN2) were followed for a period of 2–65 months. Fifty-seven biopsies were studied by the in situ hybridization (ISH) procedure for the detection of HPV 6/11 and 16/18 DNA. ISH positivity was found in 13/24 cases (54.2%); HPV 16/18 was evident in 7/9 CIN2 (77.8%) as against 3/15 CIN1 (20%) (P=0.017) and in 8/13 cases with koilocytosis affecting up to 2/3 of the epithelial thickness (61.5%) as against 2/11 cases with koilocytosis affecting more than 2/3 of the epithelial layer (18.2%) (P=0.03). Progression to CIN3 occured in 4 cases (2 CIN1 and 2 CIN2), the degree of dysplasia remained static in 5 cases (1 CIN1 and 4 CIN2) and regression occurred in 15 cases (9 CIN1 and 6 CIN2). The immunoperoxidase (IP) positive staining for PV-Ag persisted in 5/24 cases and disappeared in 19/24; 6/13 ISH positive cases maintained ISH positive and 7/13 became negative. The progression of dysplasia was significantly related to disappearance of the IP positivity (P<0.0001), to the ISH positivity (P=0.05), to the persistence of ISH positivity (P=0.008) and to HPV 16/18 positivity (P=0.01). We believe that ISH positivity for HPV 16/18 in CIN1 or 2 with low degrees of koilocytosis and conversion from PV-Ag positive to negative indicate a high risk of progression to CIN3.     

Chlamydia trachomatis infection in patients with laparoscopically verified acute salpingitis: Results of isolation and antibody determinations

Culture and serology studies have shown Chlamydia trachomatis (CT) to be one of the causes of acute salpingitis (AS). In the present investigation, results of cervical cultures were correlated with serum antibody titers to CT in patients with laparoscopically verified AS. Serum samples from 206 patients, including paired sera from 80, were assayed. Of 206 patients, 118 had chlamydial lgG antibody titers of 1:64 or more. Patients with negative cultures for CT and an lgG titer of 1:64 or more had a significantly higher geometric mean titer than corresponding patients with positive cultures. In paired sera, a seroconversion or a fourfold or greater rise in lgG titer to CT was demonstrated in 35%, while a further 11% had detectable lgM antibody in a titer of 1:8 or more. The overall isolation frequency of CT was 33%, compared with 19% for Neisseria gonorrhoeae.     

Human papillomavirus type 18 DNA sequences in adenocarcinoma and adenosquamous carcinoma of the uterine cervix

Human papillomavirus (HPV) DNA sequences were detected by Southern blot hybridization and polymerase chain reaction (PCR) in 10 out of 19 patients (52.7%) with adenocarcinoma [15] and adenosquamous [4] carcinoma of the uterine cervix. HPV 18 DNA was detected in 8 of these 19 patients (42.1%), HPV 16 DNA in 1 patient (5.3%) and HPV type X (unknown) in another (5.3%). Of the 10 HPV positive samples HPV 18 was found in 6 out of 6 pure adenocarcinomas (100%), and in 2 of 4 (50%) adenosquamous carcinomas. HPV 16 and HPV X were each detected in 1 out of 4 (25%) adenosquamous carcinomas. The physical state of the viral DNA was investigated in 5 of the 10 HPV-positive cases. All the specimens from these 5 cases showed HPV to be integrated into the host genome, except for one adenosquamous specimen, which showed both episomal and integrated forms of HPV 16. Six of 8 HPV 18 DNA positive specimens were from cases of pure adenocarcinoma and it was found by PCR that five of these 6 specimens retained fragments of E6/E7, LCR/E7 and early sequence of E1 fragment (sequence: 1188–1373) but deleted most part of E1.