A Clinicopathological Study of Adenocarcinoma in Situ of the Cervix. The Influence of Cervical HPV Infection and Other Factors, and the Role of Conservative Surgery

Adenocarcinoma in situ (ACIS) of the uterine cervix is an increasingly recognized disease. Thirty-seven cases were reviewed to determine the effect of HPV, marital status, parity, smoking habit and age on the topography and behaviour of this lesion. Using a commercial probe, 25% of 28 lesions tested were positive for HPV 16/18. The presence of HPV and a history of smoking appeared to exert no significant influence upon the topography and behaviour of ACIS. Nulliparity and a history of never being married was associated with a significant reduction in the incidence of coexisting CIN lesions. Age less than 36 years was associated with a significant reduction in the proximal linear extent of ACIS. While hysterectomy is probably the definitive treatment for ACIS of the cervix, there is an important place for conservative management by conization alone. Patients younger than 36 years are most likely to be desirous of retained fertility and appear to have the lesions most amenable to conservative surgery.     

Intralesional bleomycin sulfate in treatment of recalcitrant warts

There has long been a pressing need for an effective, easy, and safe treatment for recalcitrant warts. Intralesional injection of bleomycin promises to meet these criteria most nearly. The bleomycins, a group of sulfur-containing polypeptide compounds, were isolated from Streptomyces verticillus, a Japanese soil fungus, by Umezawa¹ in 1962. They have both antibiotic and cytotoxic properties. The cytotoxic effect depends on the ability to cause DNA strand scission, especially in dividing cells entering the mitotic phase.² It affects both DNA and protein synthesis as well as cell division.

Bleomycin is a broad-spectrum antibiotic with a variable antibacterial activity. Umezawa³ demonstrated that bleomycin also inactivated SV40 by scission of both strands of its DNA. It is possible, therefore, that it could act directly on human papillomavirus (HPV) in the same way.     

Use of Magnetic Resonance Imaging in Detection of Breast Cancer Recurrence: A Systematic Review

Background

Diagnosis of breast cancer recurrence can be difficult as a result of the presence of scar tissue in the breast. Magnetic resonance imaging (MRI) may be superior to traditional imaging in diagnosis of recurrence because of its ability to differentiate malignancy from scarring. Current guidelines on investigation of suspected breast cancer recurrence recommend MRI when other investigations have equivocal findings. We performed the first systematic review on this topic.

Methods

Literature search revealed 35 potentially relevant studies; 10 were included in final analysis. Included were clinical studies comparing MRI with another diagnostic modality for diagnosis of breast cancer recurrence, with at least 10 patients, in the English language. Data extraction focused on sensitivity and specificity of standard diagnostic modalities and MRI for diagnosis of local disease recurrence.

Results

In total 494 patients were assessed across 10 studies; all were case series. Sensitivity of MRI for detection of recurrence ranged 75?C100?%, while specificity ranged 66.6?C100?%. Both sensitivity and specificity increased when MRI was performed after a longer time interval from the original surgery, although the longest follow-up reported was only 36?months. A negative MRI can avoid the need for further biopsy.

Conclusions

Available data are based on clinically heterogeneous case series and superiority over standard triple assessment for breast cancer recurrence has not been proven. At present, MRI cannot be recommended in the routine diagnostic assessment for breast cancer recurrence but has a potentially useful role as a second-line investigation. A negative MRI is more useful than a positive MRI as positive MRIs require further investigation.     

Ueber den Zusammenhang einiger krankhafter Zustände des Magens mit anderen Organerkrankungen

Ohne ZusammenfassungSchluss von S. 197.