Langerhans cell density in cervical intraepithelial neoplasia associated with human papillomavirus infection in HIV-infected and HIV-noninfected Brazilian women.

OBJECTIVE: Local immunity plays an important role in the cervical defense mechanisms that prevent the development of cervical intraepithelial neoplasia. The objective of this study was to determine the involvement of local immunity by evaluating Langerhans cell (LC) density in cervical biopsies of human immunodeficiency virus (HIV)-positive and HIV-negative women. MATERIALS AND METHODS: A cross-sectional study was developed by including HIV-positive and HIV-negative women. All patients presented human papillomavirus DNA from the uterine cervix, which was detected by polymerase chain reaction or hybrid capture II. Cervical biopsies were assessed for LC density and cervical intraepithelial neoplasia. Langerhans cells were identified by immunohistochemistry using anti-CD1a and anti-S100 antibodies. Associations among cervical LC density, the type of cervical lesion, CD4 lymphocyte count, and HIV viral load were analyzed using logistic regression (SPSS, version 12.0). RESULTS: Seventy-seven women (40 seropositive and 37 seronegative) were enrolled. The mean ± SD LC density identified with the anti-CD1a antibody was 0.80 ± 0.7 cells versus 2.6 ± 1.6 cells (P < 0.0001), whereas the mean ± SD LC density identified by the anti-S100 antibody was 1.3 ± 1.0 cells versus 3.6 ± 1.7 cells (P < 0.0001) among the HIV-positive and HIV-negative women, respectively. There were no associations between LC density and HIV viral load, CD4 lymphocyte count, or human papillomavirus genotype (P > 0.05). In a logistic regression model, HIV infection was the only factor independently associated with a decrease in LC density. CONCLUSIONS: Human immunodeficiency virus infection was found to be an independent factor that explains the decrease in local immunity in the uterine cervix, which could allow the development of cervical lesions. This effect was not associated with CD4 lymphocyte count or HIV viral load.

Frequência de endometriose pélvica em pacientes submetidas à videolaparoscopia por dor pélvica crônica / Frequency of endometriosis in pacients assesed by laparoscopy for chronic pelvic pain

A endometriose consiste na presença de tecido endometriótico fora da cavidade uterina. O diagnóstico pode ser suspeitado pela clínica da paciente, porém exames complementares auxiliam ao diagnóstico. Objetivando avaliar a frequência de endometriose em pacientes com dor pélvica crônica, foram estudadas 120 pacientes submetidas à videolaparoscopia para diagnóstico. Os achados ultrassonográficos foram associados aos achados videolaparoscópicos e aos da histopatologia. Identificou-se 38% das pacientes com endometriose, sendo que destas, a endometriose mínima foi encontrada em 52%, a leve em 24%, a moderada em 15% e a grave em 9%. Outros achados encontrados foram: pelve normal em 12%, aderências em 25%, varizes em 18%, e outros achados em 7%. A sensibilidade da ultrassonografia para detecção dos casos leves foi baixa (14,7%), enquanto que esse valor aumentou com a gravidade da doença (72,7%). Conclui-se que a endometriose é uma patologia comum e associada aos quadros de dor pélvica crônica. A ultrassonografia normal não exclui a doença, principalmente nos casos mínimos e leves.

Endometriosis is the presence of endometrial tissue outside the uterine cavity. The diagnosis can be suspected by clinical patients, but additional tests to help diagnosis. To evaluate the frequency of endometriosis in patients with chronic pelvic pain were studied 120 patients. The ultrasonographic findings were associated with videolaparoscopic findings and histopathology. We identified 38% of patients with endometriosis and of these, the minimal endometriosis was found in 52% to 24% in mild, moderate to severe in 15% and 9%. Other findings were: normal pelvis in 12%, 25% adhesions, varices in 18% and 7% in other findings.The sensitivity of ultrasonography for detection of mild cases was low (14.7%), whereas this value increased with the severity of the disease (72.7%). We conclude that endometriosis is a common condition and associated with pictures of chronic pelvic pain. A normal ultrasound does not exclude the disease, especially in minimal cases.