Role of Intracystic Cytokines and Nitric Oxide in Ovarian Neoplasms

The development of new biomarkers for the diagnosis and prognosis of ovarian cancer may provide an opportunity for new therapies. In this study, we aimed to compare cytokines (interleukin [IL]‐2, IL‐5, IL‐6, IL‐8, IL‐10 and tumour necrosis factor [TNF]‐α) and nitric oxide (NO) metabolite levels in non‐neoplastic tumours, benign primary ovarian tumours and malignant primary ovarian neoplasms. The secondary aim was to relate cytokine and intracystic NO metabolite levels to clinical, laboratory and pathologic characteristics for patients with primary ovarian malignancies. We evaluated 110 patients with adnexal masses. Cytokine concentrations were quantified by enzyme‐linked immunosorbent assay and nitrate concentrations by enzymatic reduction of nitrite by nitrate reductase. Patients with malignant neoplasms had higher IL‐6, IL‐8 and NO levels compared to patients with benign neoplasms. Histologic grade 1 tumours were associated with elevated IL‐2 levels, whereas anaemia was associated with elevated IL‐6 levels. On average, those patients with elevated IL‐8 levels also had a neutrophil/lymphocyte ratio (NLR) greater than 2.6 and less than 36 months of disease‐free survival (DFS). Patients with normal CA 19‐9 levels had elevated IL‐10 levels. TNF‐α was elevated in patients with two carcinogenesis and those with a platelet/lymphocyte ratio (PLR) less than 300. NO levels were higher in patients with an NLR less than 2.6 and CA 19‐9 greater than 35 U/ml. Elevated intracystic cytokine levels, especially IL‐6 and IL‐8, are associated with worse prognosis in ovarian cancer.     

Intraspecies variation in Trypanosoma cruzi GPI-mucins: biological activities and differential expression of α-galactosyl residues

The glycosylphosphatidylinositol (GPI)-anchored mucins of Trypanosoma cruzi trypomastigotes play an important immunomodulatory role during the course of Chagas disease. Here, some biological activities of tGPI-mucins from four T. cruzi isolates, including benznidazole-susceptible (BZS-Y), benznidazole-resistant (BZR-Y), CL, and Colombiana, were evaluated. GPI-mucins were able to differentially trigger the production of interleukin-12 and nitric oxide in BALB/c macrophages and modulate LLC-MK2 cell invasion. The significance of these variations was assessed after analysis of the terminal α-galactosyl residues. Enzymatic treatment with α-galactosidase indicated a differential expression of O-linked α-galactosyl residues among the strains, with higher expression of this sugar in BZS-Y and BZR-Y T. cruzi populations followed by Colombiana and CL. Unweighted pair group method analysis of the carbohydrate anchor profile and biological parameters allowed the clustering of two groups. One group includes Y and CL strains (T. cruzi II and VI), and the other group is represented by Colombiana strain (T. cruzi I).     

Pulmonary capillaritis leading to alveolar hemorrhage in a juvenile idiopathic arthritis patient: first description

Juvenile idiopathic arthritis (JIA) is characterized by the typical joint involvement and some patients have extra-articular lesions, such as uveitis and pleuritis. However, until this date, no case of alveolar hemorrhage in JIA has been described. Herein, the authors describe a case of a male patient, 33?years old diagnosed as polyarticular JIA who had a dramatic evolution with alveolar hemorrhage secondary to pulmonary capillaritis. He received intravenous immunoglobulin and pulse therapies with glucocorticoid and cyclophosphamide with a satisfactory outcome. In addition, the authors review this important pulmonary complication in rheumatic diseases.     

Human papillomavirus types 16 and 18 and the prognosis of patients with stage I cervical cancer

OBJECTIVE:

This study sought to evaluate the prevalence of human papillomavirus (HPV) types 16 and 18 in women with clinical stage IB cervical cancer treated by radical hysterectomy with pelvic lymphadenectomy as well as to establish a correlation between HPV type and cancer prognosis.

METHODS:

A single-center cohort study was conducted with 86 patients who had undergone radical hysterectomy for stage I cervical cancer. Prognostic factors and the presence of HPV 16 and 18 were analyzed using a polymerase chain reaction assay. A univariate analysis using Kaplan-Meier curves was conducted to estimate survival.

RESULTS:

The prevalence of HPV 16 in the study group was 65.3%, and the prevalence of HPV 18 was 33.3%. The prevalence of infection with both viruses was 26.9%. Overall survival at 5 years was 91% among women with HPV 18 and 96% among those without this virus type (p = 0.133). Among the women with HPV 16, the overall survival was 94%, whereas this rate was 96% among those without this virus type (p = 0.663). Disease-free survival was unaffected by the presence of HPV type 16 or 18.

CONCLUSION:

In the present study, despite the high prevalence of HPV types 16 and 18, the presence of these virus types did not affect the prognosis of patients with stage I cervical cancer who underwent radical hysterectomy.     

Importance of surgical margins in conization for cervical intraepithelial neoplasia grade III

We conducted a retrospective study on 201 conizations for CIN III done over the last 14 years. Of these, 53 (26.4%) had involvement of the margins, 114 (56.7%) had margins free of neoplasia, and 34 (16.9%) were not evaluated. Of the 53 cases with margin involvement, 28 (52.8%) had complementary surgery and 25 (47.2%) cytological follow-up. Residual CIN was identified in the surgical specimen in 15 cases (53.6%) and microinvasion was present in 2 cases (7.1%). Of the 114 patients with margins free of neoplasia in the cone, 12 had a hysterectomy during follow-up for CIN III diagnosed by cytology and biopsy. Seven of these 12 patients (58.3%) had CIN in the surgical specimen and none had microinvasive cancer. Received: August 1998 / Accepted: 3 May 1999     

Increased frequency of bacterial vaginosis and Chlamydia trachomatis in pregnant women with human papillomavirus infection

The aim of this study was to verify the presence of bacterial vaginosis (BV), Candida sp, Chlamydia trachomatis, Neisseria gonorrhoeae, to determine the prevalence of tobacco use and measure vaginal pH (VpH) in pregnant women with (n = 26) and without (n = 26) human papillomavirus (HPV) infection, and make comparisons between these 2 groups. HPV, C. trachomatis and N. gonorrhoeae were diagnosed using hybrid capture, BV using clinical criteria, and Candida sp via cultures. A digital pH meter was used to measure VpH. The frequencies of Candida sp were 19.2 and 23.1% (p = 1), and VpH was 4.4 +/- 0.4 and 4.3 +/- 0.4 (p = 0.23), in the HPV-positive and HPV-negative groups, respectively. Compared to the group of pregnant women without HPV infection, those with HPV infection had a significantly higher prevalence of tobacco use (50 vs. 11.5%; p = 0.006), BV (53.8 vs. 15.4%; p = 0.007), and C. trachomatis (34.6 vs. 7.7%; p = 0.039). No case of N. gonorrhoeae was diagnosed. All cases of C. trachomatis and BV had high-grade HPV infection.     

Low-grade cervical squamous intraepithelial lesion during pregnancy: conservative antepartum management

The purpose of this retrospective study was to determine the regression rate and management of low-grade squamous intraepithelial lesions (LSIL) in pregnancy. Seventy-four women with cytological findings of LSIL were analysed during the pregnant-puerperal period (until 12 months postpartum). Age, parity, cytological and colposcopic findings, route of delivery, and postpartum follow-up were studied. The age and parity of patients ranged (average) from 12 to 32 years (21.2 +/- 4.9), 0-5 (0.89 +/- 1.14), and 9-32 years (16.1 +/- 3.5), respectively. Thirty-nine of 55 (70.9%) and 12 of 19 (63.1%) pregnant women had normal cytology after vaginal delivery and caesarean section, respectively (p > 0.05). In postpartum, eight patients (10.8%) persisted with LSIL and ten (13.5%) presented high-grade squamous intraepithelial lesions. No case of unsatisfactory colposcopy and invasive carcinoma were found. LSIL during pregnancy has a high rate of regression, regardless of the route of delivery. Conservative management with colposcopic evaluation is proposed during gestation.     

Cervical stump cancer: a study of 14 cases

Case report. This is a report on 14 patients with cervical stump cancer, aged 30 to 68 years old (median = 53 years), seen in a public university hospital. Over a 15-year period, 363 cases of cervical cancer were treated, of which fourteen (3.85%) were in the cervical stump. The time interval between subtotal hysterectomy and the diagnosis of the neoplasm varied from 9 days to 27 years (median = 9.3 years). 28.6% of the patients were in stage I, 42.9% in stage II and 28.6% in stage III. Fibromyoma was the major reason for the subtotal hysterectomy. Three patients underwent Wertheim-Meigs surgery, 1 in association with radiotherapy, and the other 11 patients had radiotherapy alone. The survival ranged from 12 to 120 months (median = 53.3 months). Conclusion. Subtotal hysterectomy should be avoided whenever possible in populations with restricted access to screening programs for cancer of the uterine cervix.     

Recovery of fertility after grafting of cryopreserved germinative tissue in female rabbits following radiotherapy

BACKGROUND: Many cancer survivors face infertility as a consequenceof the aggressive treatment they must undergo. Cryopreservationof ovarian tissue before chemotherapy or radiotherapy may allowfor tissue transplantation after the treatment, and restorationof fertility. We tested the potential of an orthotopic autograftingof cryopreserved germinative tissue in female rabbits with ovarianfailure following radiotherapy. METHODS: Ten adult multiparousfemale rabbits were randomly allocated into two groups, fivein group I (control) and five in group II (transplant). Allrabbits underwent right oophorectomy with cryopreservation ofthe germinative tissue, followed by sterilization of the remainingleft ovary by radiotherapy. Later, group II rabbits receivedin the irradiated left ovary an implant of the frozen germinativetissue from the right ovary, whose small pieces were freelyspread intracortically in a procedure we named ‘intracorticalsowing of germinative tissue’ (ISGT). RESULTS: All groupII rabbits conceived following spontaneous mating within 6 monthsof the transplant, whereas none of the remaining rabbits ingroup I had conceived up to 11 months after transplant. CONCLUSIONS:This study suggests that fertility can be restored in rabbitsby sowing cortical tissue in a previously irradiated ovary.The clinical feasibility of this technique remains to be determined.     

Frequency of glove perforation and the protective effect of double gloves in gynecological surgery

The purposes of this prospective study were to verify the frequency of glove perforation during gynecological operations and to evaluate the efficacy of double gloving in preventing damage to the inner glove. From May 2000 to May 2001, three house staff and 12 residents were asked to place their used gloves in bags labeled with the following information: procedure performed, presence of a recognized glove perforation, and role in operating team (surgeon, first or second assistant, and instrumentalist). All glove sets were tested using the method of water pression. Damaged gloves were excluded from that analysis. In all, 35 and 51 operations were utilized with single and double gloves, respectively. There were 240 single gloves and 792 double gloves tested. Perforation occurred in 10.4% of the single gloves and 9.8% of the outer double gloves. There were no cases of perforation in the inner double gloves. In cases of operating time that lasted more than 2 h, 56% of the surgeries that used single gloves had perforation vs 58.5% of the double gloves. The first assistant had the major risk for glove perforation with the use of single or double gloves. The indicator finger of the non-dominant hand was the major risk for perforation. In conclusion, we recommend double gloving in all gynecological surgery to reduce the risk of contracting blood-borne diseases.