Familial Cervical Cancer: Case Reports,Review and Clinical Implications

We report three Dutch families with familial clustering of (pre)neoplastic cervical disease, review the literature on familial risks of cervical intraepithelial neoplasia (CIN) and cervical cancer, and discuss possible practical guidelines for women with a family history of cervical cancer. Daughters and sisters of women with cervical cancer have been reported to have a relative risk of 1.5-2.3 to develop this type of cancer. From a practical clinical point of view, we suggest that as in women with an increased non-genetic risk to develop cervical cancer (e.g. because of immunosuppressive therapy) increased surveillance to detect this tumour should be considered in women with an increased risk based on family history. Cessation of smoking should be advised. As the use of condoms at least prevents HPV re-infection its use can be recommended as a way to lower the cervical cancer risk. Future studies to determine the genetic contribution to the development of cervical cancer should include the paternal family history of cancer and, because genetic predisposition might express itself as a higher risk to develop precursors of cervical cancer, carcinoma in situ and CIN grade II-III.     

Multifocal osteolysis with nephropathy

A patient with progressive osteolysis of the carpal and tarsal bones with glomerulonephritis of unusual severity is described. There was a notable absence of osteodystrophy in this and other reported cases who had chronic renal failure.     

Human fibroblast tissue factor is inhibited by lipoprotein-associated coagulation inhibitor and placental anticoagulant protein but not by apolipoprotein A-II

Studies of proteins that inhibit tissue factor activity have generally been conducted using either an extracted tissue homogenate ("thromboplastin") or tissue factor protein reconstituted into phospholipid vesicles rather than with tissue factor expressed in cell membranes (its physiological environment). In the present study, a human fibroblast cell strain was used to evaluate the effects of lipoprotein associated coagulation inhibitor (LACI), placental anticoagulant protein (PAP), and apolipoprotein A-II (apo A-II) on human tissue factor in cell membranes. LACI was tested from 7.8 to 500 pmol/L on fibroblasts cultured at cell densities ranging from 3,500 to 9,925 cells/well, and caused a progressive inhibition of tissue factor activity. PAP was tested from 3.9 nmol/L to 1 mumol/L at cell densities ranging from 4,500 to 15,400 cells/well and caused up to 83% inhibition of tissue factor activity. Inhibition by these proteins appeared to be influenced by cell density as well as whether the cells were intact or disrupted. Apo A-II, up to 1 mumol/L, did not inhibit the tissue factor activity of intact or disrupted fibroblasts at any cell density examined even though it did inhibit the activity of tissue factor in phospholipid vesicles. Of these inhibitors of tissue factor-dependent activation of factor X, LACI was the most effective in suppressing the generation of factor Xa activity. The effects obtained with apo A-II are clearly dependent on the nature of the tissue factor preparation with which it is tested. The disparity between the inhibitory effect of apo A-II on the activity of tissue factor reconstituted into lipid vesicles and the absence of effect on the activity of tissue factor remaining in cell membranes serves to reemphasize the necessity of reexamining results obtained with model systems using as nearly physiological reagents as possible.     

Bronchial artery embolization: monitoring with somatosensory evoked potentials. Work in progress

Surgery remains the treatment of choice for massive and recurrent hemoptysis. In some instances, however, immediate surgical intervention is contraindicated. In these situations, bronchial artery embolization (BAE) has proved to be a successful definitive treatment for non-surgical candidates and a palliative therapy in patients requiring hemodynamic stabilization prior to surgery. The most serious complication of BAE is spinal cord ischemia. This relates directly to the potential anastomotic connections between the bronchial circulation and the anterior spinal artery. Somatosensory evoked potentials (SSEPs) have been used in the past to monitor spinal cord ischemia during procedures that threaten the vascularity of the spinal cord. The authors report two cases in which SSEPs were employed to monitor spinal cord ischemia during bronchial artery embolization.     

Validation of a Swiss method of caries prediction in Dutch children

OBJECTIVE: This study aimed to validate a caries prediction method, the Dentoprog-Method, which was developed on Swiss children. METHOD: A Dutch child population was used for validation. The diagnosis of caries, age of the children and the caries experience were slightly different from the population from which the Dentoprog-Method was developed. With the Dentoprog-Method, Dutch children were ranked in increasing order of high caries risk probability. The measure of prediction was expressed in sensitivity and specificity, which were calculated at 10% risk probability intervals for each class of "high" caries increment and for different forecast periods. ROC curves presenting sensitivity as a function of (100-specificity) were employed to summarize the obtained information. The area under the ROC curve was used as a measure of predictive accuracy. RESULTS: The area under the ROC curves for various caries increment classes of 7.5-year-old and 9.5-year-old Dutch children was in the range of the area under the ROC curves of Swiss children. CONCLUSION: This analysis indicated that the Dentoprog-Method when applied on a sample of Dutch children was robust enough to overcome small differences in caries diagnosis, age and caries experience.     

Prevalence of caries, plaque and gingivitis in an urban and rural Tanzanian child population

A longitudinal study of the oral condition of 763 schoolchildren was started in the Morogoro District of the Republic of Tanzania in 1984. The average baseline D3MFT scores of the 7-, 8- and -9-yr-old urban and rural children were 0.27, 0.33, 0.35 and 0.04, 0.23 and 0.23, respectively; the average deft values were 2.9, 2.4, 2.6 and 1.4, 1.9 and 1.4. The permanent dentition was caries free (D3MFT = 0) in 80 and 89% of the urban and rural children, respectively. Gingivitis was prevalent in rural (61%) and urban (55%) children; visible plaque was present in 93% of the children in both subsamples. The results of this baseline study show that the child population under study reflects the national Tanzanian situation with higher caries prevalence in urban than in rural children.     

Plaque, calculus, gingival bleeding and type of tooth cleaning device in a Tanzanian child population in 1984,1986 and 1988

In 1984, 1986 and 1988 a mixed-longitudinal study was carried out to determine the prevalence of plaque, calculus, gingival bleeding and type of tooth cleaning device amongst school children in Morogoro, Tanzania. The background parameters considered were age, geographical location and sex. The reproducibility of the methods of diagnosis was assessed. In general, more children possessed a chewing stick than a toothbrush, except urban children. The prevalence of visible plaque decreased and the prevalence of calculus increased with increasing age. Gingival bleeding was not age-dependent. Urban children had significantly more surfaces covered with visible plaque, but had a significantly lower prevalence of calculus, than rural children. Boys showed a significantly higher prevalence of visible plaque and calculus than girls. In the majority of those with gingival bleeding, only 1 of the 6 examined papillae was involved, most often the mesio-lingual papilla of the 3.6. The children had not been subjected to organized oral health care and professional intervention. The findings of the study indicate the need for organized school-based oral hygiene programmes in the area in order to improve the periodontal health of these children.     

Tooth loss and dental caries in Dutch adults

As part of a nationwide dental survey in 1986 a caries study was executed in 3526 adults, aged 15-74 yr, living in 40 residential areas in The Netherlands. Marked differences were found between the social classes distinguished (more edentates in the lower classes) and between the different regions. It is supposed that these differences reflect the lack of dental manpower in the past.     

Transient synovitis of the hip in children: role of US

Transient synovitis of the hip remains a common diagnostic problem for the clinician. The physical signs are not pathognomonic of the condition, and the classic technical examinations are of little help. Therefore, the authors retrospectively studied the value of hip arthrosonography in 46 children with clinical symptoms suggesting pathologic hip conditions. In 20 of the 21 patients with a final diagnosis of transient synovitis, articular effusion was detected on ultrasound (US). Conventional radiography showed an increased medial joint space in only eight of these patients. Increased echogenicity of the articular fluid was found in both transient synovitis and septic arthritis. The high sensitivity of US in detecting intraarticular fluid was demonstrated by cadaver studies.