Comparative study of systemic interferon alfa-2a plus isotretinoin versus isotretinoin in the treatment of recurrent condyloma acuminatum in men.

OBJECTIVES: Purpose of the present study was to evaluate the effectiveness of isotretinoin versus interferon alfa-2a plus isotretinoin in the treatment of recurrent condyloma acuminatum in 86 men. METHODS: Men were randomly assigned to group A (n = 42) who received isotretinoin 1 mg/kg orally daily until remission was achieved, but not more than 3 months, or to group B (n = 44) who received interferon alfa-2a 3 x 10(5) IU subcutaneously three times weekly until remission was achieved, but not more than 8 weeks, plus isotretinoin in the same dosage as in group A. RESULTS: The reduced duration of treatment to achieve remission was statistically significant in group B (2.18 versus 2.5 months; P < 0.01) and the recurrence rate was less in group B (4 of 44 versus 16 of 42; P < 0.01). CONCLUSIONS: The results of this study are encouraging and demonstrated that the combination of isotretinoin plus interferon alfa-2a achieves higher remission rates and a shorter duration of treatment than isotretinoin alone.

The effects of recombinant human erythropoietin given immediately after delivery to women with anaemia.

OBJECTIVE: Anaemia is a common problem during pregnancy and the puerperium. This study was designed to determine the efficacy and safety of giving recombinant human erythropoietin (EPO) to anaemic women during the puerperium. METHOD: Thirty-seven women received a single dose of EPO (20 000 IU intravenously) immediately after delivery. A control population (n = 37) matched according to age and haemoglobin concentration was evaluated. All women received oral iron supplementation for 40 days after delivery. Haemoglobin concentrations were measured 4 and 40 days after delivery. Blood transfusions were given depending on clinical condition and haemoglobin level. RESULTS: Patients treated with EPO had a significantly higher mean haemoglobin concentration than control patients at days 4 and 40. No women in the EPO group required a transfusion, compared with six in the control group. No side-effects and fewer anaemia-related symptoms were observed during EPO treatment. CONCLUSION: EPO given at delivery is effective in decreasing the need for blood transfusion and the incidence of problems associated with anaemia during the puerperium.

Treatment of flat or accuminata condylomata of female genital tract.

This prospective study was undertaken to test the hypothesis that if the male partners of women with condylomata accuminata or flat are treated, the treatment failure rate, of women, decreases. From March 1986 to October 1992, 246 women with condylomata accuminata or flat were presented. The women were assigned into 4 groups. Group A (n=64) women whose partners were submitted to peoscopy and then treated if appropriate; moreover condom use was prescribed for one year. Group B (n=79) women whose partners were not submitted to peoscopy and not treated but they used condoms for one year. Group C (n=40) women whose partners were submitted to peoscopy and then treated if appropriate but without the use of condoms. Group D (n=63) women whose partners were not submitted to peoscopy, not treated and without the use of condoms. The treatment failure rate of women of group A (peoscopy, treatment, condom) was 29.68% and was independent upon the treatment of male sexual partners because of the use of condom (chi(2)=2.32, p>0.1). The treatment failure rate of group B (no peoscopy, no treatment, condom) was 32.91%. The treatment failure rate of group C (peoscopy, treatment, no condom) was 47.5% and was dependent upon the treatment of male sexual partners (chi(2)=14.71, p<0.001). The treatment failure rate of group D (no peoscopy, no treatment, no condom) was 69.84%. The results of this study supports the hypothesis that the treatment failure rate of women with flat or accuminata condylomata decreases if their male sexual partners are also treated.

Treatment of cervical intraepithelial neoplasia (CIN) with interferon alpha-2a, CO2 laser (vaporization, cone) and 5-fluorouracil.

This study was undertaken to assess the effect of CO2 laser (vaporization, conization), 5-FU topical application and interferon alpha-2a parenterally in the therapy of GIN. Three hundred and forty-seven (347) women with CIN were treated with CO2 laser (vaporization, conization), 5-FU topical application and interferon alpha-2a parenterally. The cure rates in the various treatment groups were analysed by the chi(2) test. The most effective treatment used for CIN I was the combination of CO2 laser vaporization plus 5-FU (p<0.05). The most effective treatment used for CIN II was the combination of CO2 laser vaporization plus 5-FU (p<0.001). The treatment modalities used for patients with CIN III achieved the same therapeutic results (p>0.1). The addition of interferon does not achieve better cure rates in patients with CIN.

Peoscopic diagnosis of flat condyloma and penile intraepithelial neoplasia V scrotal reservoir.

The aim of the present study was to evaluate prospectively male sexual partners of women with flat condyloma (FC) or accuminata (CA) or cervical intraepithelial neoplasia (CIN) and to determine the incidence of scrotal involvement by HPV. Of the 218 patients, 20 (9.17%) revealed areas of acetowhite epithelium involving the anterior lateral and superior aspects of the scrotum. Eight patients (40%) also presented concomitant small telangiectatic lesions measuring 1-3 mm of the scrotum in the acetowhite areas, and one patient presented scrotal intraepithelial neoplasia grade I (SIN I). The new combination treatment schedule (cream 5-fluorouracil 5% + Interferon alpha-2 alpha) resulted in a 100% cure rate, with no recurrences for the follow-up period (11.52 months). Concluding, the scrotum appears to be an important and presently overlooked area in the evaluation of male patients, and interferon in combination with 5-FU cream seems to be a promising treatment for HPV infection.

Treatment of flat or accuminata condylomata of the female genital tract with interferon alpha-2 alpha.

This study was undertaken to assess the effectiveness of Interferon administered parenterally in the treatment of flat or accuminata condylomata of the female genital tract. One hundred and forty-three women with condylomata were treated with CO2 laser vaporization, 5-FU topical application and interferon alpha-2 alpha (IFN alpha-2 alpha) parenterally. The cure rates in the various treatment groups were analysed by the chi-square test. The cure rates of the treatments used in the patients with condylomata accuminata were similar (p>0.1). The best cure rate for flat condylomata was achieved with the combination of CO2 laser vaporization plus 5-FU plus IFN alpha-2 alpha (high dose) (p<0.01). In conclusion, Interferon can be used as adjuvant treatment in patients with recalcitrant condylomata accuminata and as first line treatment in combination with 5-FU and CO2 laser vaporization in patients with flat condylomata.

Sex hormones in women on hemodialysis.

The pituitary-ovarian axis was studied in 12 women with a creatinine clearance of less than 5 ml/min per 17 m2, established on regular hemodialysis for at least 12 months. Follicle stimulating hormone (FSH) serum levels were found to be slightly lower than normal, luteinizing hormone (LH) plasma concentration generally elevated, while progesterone and estradiol values were extremely low. The major reproductive consequence of chronic renal failure in women on hemodialysis is a severe impairment in ovulatory function.

Correlation between histopathologic features and estrogen receptor status in primary breast cancer.

Relationships between certain histopathologic features of tumor specimens and estrogen receptor (ER) status were investigated. Lobular and ductal carcinomas were found to be richer in ER than other histologic types. Well differentiated carcinomas were more often hormone receptor positive than poorly differentiated tumors. Lymphocytic and plasmatocytic infiltration in and around the tumor as well as elastosis also appeared to be related positively to ER status.

Treatment of men with flat (FC) or acuminata (CA) condylomata with interferon alpha-2a.

This study was undertaken to assess the effect of CO2 laser vaporization, 5-fluorouracil 5% (5-FU) topical application and Interferon alpha-2a (IFA alpha-2a) in the treatment of C.A. or F.C. of the male genital tract. From March 1986 to September 1991, 1372 men, sexual partners of women with F.C. or C.A. or cervical intraepithelial neoplasia, were submitted to peoscopy. One thousand and nineteen (74.27%) men presented with various penile lesions caused by HPV (histologically confirmed); of these 505 were treated for C.A. or F.C. or a combination of F.C. and C.A. The best treatment modalities, irrespective of the kind of lesion, were found to be the combination of 5-FU plus IFN alpha-2a (high dose) (98.27%), the combination of CO2 laser vaporization plus 5-FU plus IFN alpha-2a (high dose) (93.93%) and the combination of CO2 laser vaporization plus 5-FU (87.23%). In conclusion we believe that IFN alpha-2a can be used with excellent results as first line treatment in combination with CO2 laser vaporization or/plus 5-FU in patients with C.A. or F.C. or combined condylomata.

Treatment of penile intraepithelial neoplasia (PIN) with interferon alpha-2a, CO2 laser (vaporization) and 5-fluorouracil 5% (5-FU).

This study was undertaken to assess the effectiveness of CO2 laser (vaporization), 5-FU topical application and Interferon (IFN alpha-2a) parenterally in the therapy of penile intraepithelial neoplasia (PIN). From March 1986 to September 1991, 1,372 men, sexual partners of women with condylomata accuminata or flat or cervical intraepithelial neoplasia (CIN), were submitted to peoscopy, of 1,019 men who presented with various lesions caused by human papillomavirus (HPV)-confirmed histologically-208 were treated for PIN. The best treatment modalities irrespective of grade of lesion were found to be the combination of 5-FU plus CO2 laser vaporisation plus IFN alpha-2a (high dose) (96.15%), the combination of 5-FU plus CO2 laser vaporization (87.09%) and the combination of CO2 laser vaporization plus IFN alpha-2a (high dose) (80%). It is concluded that IFN alpha-2a (low dose) can be used as first line treatment in combination with 5-FU in patients with PIN II and as an adjuvant treatment (high dose) in patients with recurrent PIN I and PIN III.

[The copper IUD and gonococcus]. / D.I.U. au cuivre et gonocoques.

PIP: The sensitivity of 66 gonococcus strains isolated from 35 men and 31 women suffering purulent secretion from the urethra was tested in vitro by determination of the inhibition zone to 3 antibiotics and to pure copper. Inhibition of gonococcus growth by copper were also studied in vivo in 15 women with positive cultures following the insertion of an IUD with pure copper. Observations following IUD insertion were very promising and gave completely negative results of the culture and the direct specimen in all but 1 case in which the disease had been localized in the cervical mucus. (author's)^ieng

Immunopathology of the implantation site utilizing monoclonal antibodies to natural killer cells in women with recurrent pregnancy losses.

PROBLEM: Placental lesions of 71 women with documented recurrent spontaneous abortions of unknown etiology were evaluated using immunohistochemical staining. METHOD OF STUDY: Placental tissue blocks (less than 12 weeks gestation) from prior pregnancy losses were obtained, recut, and analyzed utilizing monoclonal antibody to identify the trophoblast (cytokeratin 8/18) and natural killer (NK) cells (CD57) at the implantation site. The following features were evaluated: trophoblast invasion pattern; syncytium formation; vasculitis and thromboembolism of decidual vessels; decidual inflammation; decidual necrosis; fibrin deposition at the decidual necrosis site; mononuclear-cell infiltration in villi and intervillous space; perivillous fibrin deposition; trophoblast morphology; and quantitation of CD57+ NK cells within the decidual tissue near the implantation site. Controls consisted of 20 healthy women with no history of recurrent pregnancy losses, who had their pregnancies electively terminated. RESULTS: Of the women studied, 29.6% demonstrated elevated CD57+ NK cells at the implantation site (P = 0.030), 54.1% had inadequate cytotrophoblast invasion depth (P = 0.000), 44.1% demonstrated inadequate syncytium formation (P = 0.004), and 33.9% presented thromboembolism in decidual vessels (P = 0.025). CONCLUSION: Some women with recurrent spontaneous abortions demonstrate abnormal placental lesions at the implantation site. Immunopathologic evaluation of the placental implantation site that terminated in a spontaneous abortion may reveal the immunopathogenesis of previous pregnancy losses.

Treatment of urethral condylomata acuminata or flat condylomata with interferon-alpha 2a.

The effectiveness of intraurethral 5-fluorouracil and systemic administration of interferon-alpha 2a in the therapy of condylomata acuminata or flat condylomata of the urethra is assessed. From March 1986 to September 1991, 1,372 male sexual partners of women with condylomata acuminata, flat condylomata or cervical intraepithelial neoplasia underwent urethroscopy and brush cytological examination of the urethra. Of these men 305 (22.23%) had intraepithelial human papillomavirus (confirmed cytologically) and 284 were treated. The best treatment modalities, regardless of the type of lesion, were the combinations of 5-fluorouracil plus high (95.34%) and low (70.58%) dose interferon-alpha 2a. Interferon-alpha 2a can be used as first line treatment with 5-fluorouracil cream in patients with intraurethral condylomata acuminata or flat condylomata.

Treatment of recurrent genital herpes with interferon alpha-2alpha.

The purpose of the present study was to evaluate the efficacy and safety of parenteral administration of interferon alpha-2alpha in the treatment of recurrent herpes genitalis. A total of 97 patients (66 males, 31 females, mean age 34.86 +/-16.74 years), who had at least five recurrences of genital herpes during the previous 12 months, participated in a prospective open study on the effects of treatment with interferon alpha-2alpha (Roferon-A; Roche). The patients were treated with interferon alpha-2alpha (3 x 10(6) IU) by subcutaneous injection, three times weekly for 4 weeks, and the same schedule was repeated after 3 and 6 months. All patients were asymptomatic at the start of the study. After initiation of treatment, all patients reported to the clinic every 3 months for 2 years (the males were submitted to peoscopy and the females to Pap test and colposcopy) at the time of their recurrences. Comparison was made of the number of recurrences, duration of lesions, duration and severity of pain, and itching and burning. Prophylactic administration of interferon alpha-2alpha prevented recurrences of genital herpes virus infection in 51 patients (20 males and 31 females). Interferon administration shortened the healing time from 8.5 days before treatment to 2.5 days after treatment (p < 0.001). There was a significant reduction in the number of recurrences during the study period, from 7.46 before treatment to 2.64 after treatment (p < 0.001). On the basis of the overall efficacy and adverse effects, this regimen may be of value in the routine treatment of recurrent herpes.

Status of peripheral blood natural killer cells in women with recurrent spontaneous abortions and infertility of unknown aetiology.

The aim of this study was to investigate the functional status and immunophenotypic characteristics of natural killer (NK) cells in women who suffer recurrent spontaneous abortions (RSA) or have infertility of unknown aetiology. Peripheral blood mononuclear cells (PBMC) were obtained from 40 study patients and 13 normal healthy multiparous controls. NK cells were identified using anti-CD56 and anti-CD16 monoclonal antibodies (mAb). The expression of CD69, CD25, CD122, CD30, CD154, CD128 and CD94 on NK cells was detected using specific mAb and analysed by flow cytometry. CD69 expression on NK cells after ED(27) human trophoblast cell line co-culture with PBMC was also investigated. A significant increase in CD69 expression on CD56(+) NK cells was demonstrated in women with RSA (P < 0.005) and infertility (P < 0.05) as compared with that of normal controls. Conversely, CD94 expression was significantly decreased in women with RSA (P < 0.005) and infertility (P < 0.05) in comparison with that of controls. Increased CD69 expression on NK cells was induced after 24 h co-culture with ED(27). In conclusion, peripheral blood NK cells of women with RSA and infertility of unknown aetiology have higher proportions of activated NK cells in vivo. Unbalanced CD69 and CD94 expression may explain the underlying pathology.

Increased resistance to activated protein C and factor V Leiden in recurrent abortions. Review of other hypercoagulability factors.

OBJECTIVE: To evaluate hereditary and acquired hemostatic abnormalities associated with recurrent spontaneous early (first-trimester) abortions. METHOD: A group of 56 Greek women with two or more unexplained primary spontaneous abortions, and a reference group of 148 women without a history of recurrent abortions, were screened for hypercoagulability. A randomly selected population of first-trimester pregnant women was also chosen for factor V Leiden genetic screening. RESULTS: A total of 21% of the women with recurrent abortions, compared with 12% of the reference group, showed increased activated protein C resistance. Fourteen per cent had positive lupus anticoagulant, compared with 11.5% of the reference group. For the rest of the parameters, there was no difference between the two groups. Of 22 women studied for factor V Leiden, one was homozygous and one was heterozygous. Results were compared using Fisher's exact test and two-tailed Student's t tests. CONCLUSIONS: Increased activated protein C resistance appears to be an important factor in women with recurrent abortions. These data indicate the need for routine investigation of activated protein C resistance in women with recurrent abortions.