Colposcopy as a method of management strategy in CIN and microinvasive cancer

During nearly 40 years of using colposcopy, an original management strategy in CIN and early cervical cancer was developed and confirmed in 2 study groups of cervical lesions containing respectively 1228 and 6001 cases. This approach is based on colposcopy as the main method in early detection of CIN and cancer, with supplementary cytology in necessary cases, and on a coloposcopic-histological staging of these lesions for treatment qualification. Colposcopy alone is a fairly adequate method for diagnosis of 60% of examined cases, and coloscopy with directed biopsy in the next 20% of colposcopically highly suspect findings. Only in the remaining 20% of colposcopically less suspect findings and in the cases of "unsatisfactory colposcopy", supplementary was cytology required. In this study colposcopy findings connected with histological evaluation of the specimens provided a basic way for determining the advancement of processes and the selection method for the appropriate type and extent of treatment. CIN 1 and 2 and small focuses of CIN 3 including CIS entirely visible on the ectocervix, in childless young women were treated by cryosurgery. In all remaining cases of CIN 3, the basic therapeutic method was cold-knife conization. In exceptional cases simple hysterectomy can be a more adequate treatment. Depending on our colposcopic-histological staging, in Stage IA1--conization, whereas in Stage IA2--a moderately extended hysterectomy should be optionally performed. The management strategy introduced is an economical, fully effective and quick way of detection and selection of the method for the treatment of CIN and early cervical cancer.     

The differences in testicular volumes in boys 8-36 months old with undescended, retractile and hydrocele testis--usefulness of scrotal screening ultrasound

Purpose

The aim of the study was quantitative and qualitative assessments of scrotal abnormalities diagnosed in boys 8 to 36 months old during ultrasound screening and estimation if these abnormalities influence testes volume.

Materials and methods

High frequency scrotal ultrasound was performed in 1448 patients aged 8–36 months as additional exam during screening ultrasound program for children including cervical and abdominal ultrasound. The mean age of examined boys was 17 months. For further analysis the children were divided in 5 age groups.

Results

The abnormalities in scrotal ultrasound were found in 20.1% of boys. Undescended, cryptorchid testes were found in 4.8% of patients, mobile testicle in 7.6% and hydrocele in 2.8%. The volume of undescended testes was statistically lower than volume of the descended testes in 3 youngest groups of boys (p = 0.003–0.011). The volume of mobile testicles did not increase with age, while in patients with hydrocele the testicular volume decreased with age.

Conclusion

Scrotal screening ultrasound performed in boys up to 3 years old may deliver information about the number and type of existing pathologies as well as their influence on the testicular volume. The volume of the pathological testes was lower than the volume of the normal ones. Improper growth of testes may potentially have important clinical implication for the function of testes in the future.     

The long-term effectiveness of generic adult fixed-dose combination antiretroviral therapy for HIV-infected Ugandan children

Background

Access to pediatric antiretroviral formulations is increasing in resource-limited countries, however adult FDCs are still commonly used by antiretroviral therapy (ART) programs.

Objective

To describe long-term effectiveness of using adult FDC of d4T+3TC+NVP (Triomune) in children for HIV treatment.

Methods

Clinical, immunologic, and virologic outcomes of HIV-infected ART-naïve children aged six months to 12 years, were evaluated up to 96 weeks post-ART initiation.

Results

From March 2004 to June 2006, 104 children were followed with a median age of 5.4 years, median CD4 cell percent and HIV-1 RNA were 11.0% (IQR 6.7–13.9) and 348,846copies/mL (IQR 160,941–681,313) respectively at baseline. Using Kaplan-Meir estimates, 75% of children had undetectable viral loads (<400copies/mL) at 96weeks of ART. Children with a baseline CD4 cell percent >15% were 3 times more likely to achieve viral load <400copies/mL than those with baseline CD4 cell percent <5% after adjusting for baseline age {aHR = 3.03 (1.10–8.32), p=0.03}; no difference was found among those with CD4 cell percent >5–14.9% and <5%.

Conclusion

Treatment with generic adult FDC for HIV-infected Ugandan children led to sustained clinical, immunologic and virologic response during 96 weeks of ART. Early initiation of ART is key to achieving virological success.     

Expression of extracellular matrix metalloproteinase (MMP-9), E-cadherin and proliferation-associated antigen Ki-67 and their reciprocal correlation in canine mammary adenocarcinomas

BACKGROUND: The purpose of the present study was to determine the expression of the proteins related to tumour metastatic potential, including matrix metalloproteinase (MMP)-9 and E-cadherin, in correlation with the expression of proliferation-associated antigen (Ki-67) in canine mammary adenocarcinomas. MATERIALS AND METHODS: Material for the studies was obtained during surgery from 35 dogs of various breeds, aged 7 to 16 years. Neoplastic tumours were verified by a pathologist. The studied proteins were detected by immunohistochemical reactions. The microphotographs of the studied tumours were subjected to computer-assisted image analysis using MultiScaneBase V 14.02 software. RESULTS: Expression of MMP-9 was noted in almost 83% of the tumours, expression of E-cadherin in 77% of tumours, while expression of Ki-67 antigen was detected in fewer than 26% of studied tumours. CONCLUSION: The positive correlation (r=0.375) between expressions of MMP-9 and Ki-67 and negative correlations between E-cadherin and Ki-67 (r=-0.383) as well as between MMP-9 and E-cadherin (r=-0.45) could suggest that expression and biological significance of the studied markers in mammary adenocarcinomas in dogs resembles the pattern noted in ductal carcinoma, i.e. in the most frequent histological type of malignant tumour in humans. This may point to suitability of the animal model in studies on mechanism of neoplasia and metastases in humans.     

NK and NKT-like cells in granulomatous and fibrotic lung diseases

Clinical and Experimental Medicine - Background The pathogenetic and regulatory roles of natural killer (NK) and natural killer T-like cells in interstitial lung diseases (ILDs), fibrotic and...