Repeat conisation or HPV test? What should be done if histology of the primary conisation requires a second conisation?

OBJECTIVE: In our retrospective study we focused on the sensitivity of HPV DNA testing towards reducing the number of repeat (re)conisations. Is the second HPV test (pre repeat conisation) an appropriate method to reduce the number of interventions in histologically positive cases? STUDY: 438 cervical conisations--loop electrosurgical excision procedure (LEEP)--were performed between March 2008 and August 2010 at our Gynaecology Department. Samples for high-risk HPV testing (Genoid, Hungary) were taken from the surface of the cervix and from the cervical canal before the LEEP procedure, and histopathological examinations were performed. Margin positivity was the indication for re-conisation (re-LEEP). RESULTS: 119 (27.2%) out of 438 cases were re-conisations. In cases of histologically proven residual dysplasia (29 of 119) high-risk HPV infection was also detected by HPV testing. In 90 cases of 119 residual dysplasia was not seen by histological examination. In this high-risk group HPV infection had not been detected in 77 cases (85.5%) by the time the second HPV test was performed. HPV tests for high-risk types were positive only in 13 of 90 (14.5%) without residual dysplasia. Furthermore the same HPV type was detected only in three cases taken before the first and second conisation procedure. CONCLUSION: Pre re-conisation HPV testing might be useful in reducing the number of re-conisations where the high-risk HPV test is either negative or does not confirm the previously proven HPV type.

ErbB-2/HER-2 protein expression, serum tumour necrosis factor-alpha (TFM-alpha) and soluble tumour necrosis factor receptor-2 (TNFR-2) concentrations in human carcinoma of the uterine cervix.

The expression of erbB-2 protein (by immunohistochemistry), serum TNF-alpha, soluble TNF-receptor 2 (sTNFR-2, ELISA) concentrations and mitogenic (LPS, ConA, PHA) induced TNF-alpha production of the peripheral blood mononuclear cells (PBMNC) were studied in 91 (UICC Stage 1: 39, Stage 2: 33, Stage 3: 14, Stage 4: 5) patients with carcinoma of the uterine cervix. During a follow-up period of seven years 30 patients died (Stage 4: 5, Stage 3: 12, Stage 2: 11, Stage 1: 2). ErbB-2 protein expression was significantly more frequent in patients with UICC Stages 3-4 (14/19), and in those with fatal outcomes (14/30, p < 0.0001, chi-square test). Serum TNF-alpha (2.70 +/- 0.69 pg/ml) and sTNFR-2 (3.85 +/- 1.05 ng/ml) concentrations were significantly lower in cancer patients (p < 0.0001, Mann-Whitney test) as compared to 64 age-matched control women (TNF-alpha: 4.32 +/- 0.36, TNFR-2: 4.85 +/- 0.82). The mitogenic induced TNF-alpha production of PBMNC was also significantly less with all the three mitogens applied (LPS: 35.24 +/- 8.84, ConA: 26.28 +/- 7.81, PHA: 20.48 +/- 7.04 pg/l million of cells/24 hours, p < 0.0001) as compared to the controls (LPS: 65.33 +/- 8.82, ConA: 51.00 +/- 8.87, PHA: 41.80 +/- 9.01). Serum TNF-alpha, sTNFR-2 concentrations and the mitogenic induced TNF-alpha production of PBMNC was significantly decreased in patients with erbB-2 positivity as compared to those with negativity. In conclusion the expression of the oncoprotein and the lower levels of the members of the TNF system seem to be poor prognostic parameters in patients with carcinoma of the uterine cervix.

Role of tumour necrosis factor-alpha in insulin resistance during normal pregnancy.

OBJECTIVE: Role of tumour necrosis factor-alpha (TNF-alpha) was studied in insulin resistance during pregnancy. STUDY DESIGN: Serum TNF-alpha (ELISA) and fasting C-peptide (Cp) (RIA) concentrations were measured in 40 healthy pregnant women (15, 12 and 13 of them in the 1st, 2nd and 3rd trimesters, respectively) and in 25 healthy non-pregnant women in a case-control study. RESULTS: TNF-alpha (X+/-S.D.: 5.33+/-0.46 pg/ml) and Cp levels (3.37+/-1.30 ng/ml) were significantly higher in the 3rd trimester as compared with matched healthy controls (TNF: 4.07+/-0.26, Cp: 1.05+/-0.36) and to the pregnant women in 1st (TNF: 4.04+/-0.26, Cp: 1.34+/-0.59) and 2nd (TNF: 4.35+/-0.32, Cp: 1.11+/-0.35) trimesters. Significant positive linear correlation was calculated among TNF-alpha, Cp, Cp/blood glucose ratio (indirect parameters of insulin resistance) and body mass indexes (BMIs) of pregnant women (P<0.01). CONCLUSION: TNF-alpha may contribute to the insulin resistance during the course of normal pregnancy.

A simplified version of the "Indiana pouch" technique for urinary diversion. Experience of the first 18 cases.

During the last 3 years, a modified technique of the continent urinary diversion, known as the "Indiana pouch" has been performed in 18 patients as part of pelvic exenteration. The narrowing of the ileum and/or the site of Bauchin valve was excluded from the procedure. In order to achieve anti reflux effect, ureters were implanted to the urinary reservoir by the "split cuff nipple" technique instead of tunnelling ureters. Sufficient urine continence and lack of urine reflux in the ureters indicated that satisfactory function could be achieved by the simplified technique. A quality of life questionnaire has suggested that most of our modified Indiana Pouch patients coped well. Operative technique, indications, operative results, and complications are discussed.

[K-cell activity in patients with germ cell testicular tumors. Effect of cytostatic therapy]. / Csírasejt eredetü heredaganatban szenvedök K-sejt aktivitásának vizsgálata. A citosztatikus kezelés hatása.

The antibody-dependent cell mediated cytotoxicity of peripheral blood mononuclear cells from 92 patients with germinal cell tumours and 60 healthy male controls was measured against 0, Rh(D) positive human red blood cells sensitized with anti-D antibody. To determine the maximal K-cell activity the enzym-like kinetic model of citotoxicity was employed in which maximal activity was measured in presence of target-cell excess. To avoid variation due to the individual sensitivity of target erythrocytes red blood cells were obtained from a single donor. It was demonstrated that compared to the control group the K-cell activity of patients with germinal cell tumours was significantly enhanced. Cytotoxic activity of patients with clinically detectable tumours was significantly higher than that of patients with no detectable tumour. The K-cell activity of patients with detectable tumours was significantly increased after chemotherapy.

Experience with a new combined method in the differential diagnostics of early endometrial changes.

The authors have performed in 30 cases ultrasonic examination of the endometrium followed by vacuum aspiration with TIS-U-TRAP device (Milex Prod. Inc., Chicago) with equipped a transvaginal head, to obtain samples for histological examination. In 8 of the 30 cases endometrial hyperplasia, while in 2 cases endometrial adenocarcinoma was verified. The authors suggest that transvaginal ultrasonic examination together with vacuum aspiration is suitable for oncological screening of the endometrium.

[Prospective study of K-cell activity in patients with malignant gynecologic tumors. Effect of radiation therapy]. / Rosszindulatú nögyógyászati daganatos megbetegedésben szenvedö betegek K-sejt aktivitásának prospectiv vizsgálata. A sugárkezelés és mütét hatása.

K cell activity was measured in the enzyme-like kinetic model of cytotoxicity against O, Rh (D) positive erythrocytes in 127 patients with carcinoma of the uterine cervix, 55 with carcinoma of the corpus uteri and 30 with malignant tumors of the ovary. The control groups included 62 healthy age matched women and 39 patients with benign tumor of the ovary. The cytotoxic activity was measured in a number of cases before any treatment and after irradiation and surgery in patients with cervical and endometrial cancer. The target cells were obtained from the same donor. ADCC activity of cervical and ovarian tumor patients enhanced depends on the stage of the disease. K cell activity of endometrial carcinoma patients was similar to the controls. ADCC activity of patients with carcinoma of the uterine cervix was increased, with carcinoma of the uterine corpus was indicated an increasing tendency following irradiation. There was connection with the dose of the irradiation and K cell activity. On the contrary, operation did not influence ADCC activity.

Quantitative comparison of serum steroid and peptide hormone concentrations in male and female fetuses in the maternal-fetoplacental system during the 28th-40th weeks of pregnancy.

There are a great deal of data concerning the role of testosterone in the formation of the sex of the fetus. The synthesis of the testosterone is influenced by the hypophysis and the fetoplacental unit. In this study the authors conferred the progesterone, DHAS, cortisol, oestradiol, oestriol, prolactin and HPL levels of male and female newborns in the maternal vein and in the umbilical vein and artery in the 28th-32th weeks (31 parturients, 15 male and 16 female fetuses), in the 33rd-36th weeks (43 parturients, 20 male and 23 female fetuses) and in the 40th week (34 parturients, 11 male and 23 female fetuses) of pregnancy. The determination of serum hormone concentration was carried out with the RIA method in 2084 samples. There was no significant difference between the serum hormone concentrations of the male and female sex in the 28th-40th weeks of pregnancy. They assume that in the 28th-40th weeks there is no difference in the activity of steroid and peptide hormone secretion caused by the sex of the fetus.

Serum DHAS in the maternal-fetoplacental system during the 28th-40th weeks of pregnancy.

The authors measured the serum levels of dehydroepiandrosterone sulfate (DHAS) in the maternal vein (MV), the umbilical vein (UV) and the umbilical artery (UA) during the 28th-36th weeks of pregnancy (n = 74) and in the 40th week (n = 34), to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found: (1) The DHAS concentration increased significantly in MV, up to twice the concentration from the 28th-32nd weeks to the 33rd-36th weeks (p less than 0.01). From the 33rd-36th weeks to the 40th week it decreased significantly to one third of this value (p less than 0.01). DHAS levels revealed a decreasing tendency in the UA and UV serum from the 28th-32nd weeks to the 33rd-36th weeks, and there was a tendency to rise from the 33rd-36th weeks to the 40th week. (2) The serum DHAS values were found to be higher than in the MV, the UA-UV difference was not significant; however, the 'UA/UV X 100' value remained higher than 100% during the 28th-40th weeks. (3) The MV DHAS value showed slight correlation with the UV and UA DHAS concentration (r = 0.2951, p less than 0.01, n = 106; r = 0.2930, p less than 0.01, n = 100). There was a close correlation between the UV and UA serum DHAS levels (r = 0.8432, p less than 0.01, n = 98). The authors consider that the adrenal activity increases independently of the maternal adrenal cortex at term.

Perinatal progesterone in maternal-fetoplacental system during mature and premature deliveries.

The role of the maternal-fetoplacental hormonal system in the maintenance of pregnancy and in the onset of labor was studied by measuring the serum progesterone level in the maternal vein, the umbilical vein and artery at term (n = 34) and in the case of premature births (n = 74). Our results show: 1) During the 28th-40th weeks the serum progesterone concentration in the umbilical vein is greater than in the maternal vein (p less than 0.01) and in the umbilical artery (p less than 0.01), and greater in the umbilical artery then in the maternal vein (p less than 0.01). 2) No correlation was found between the serum progesterone concentration in the maternal and fetal vessels, whereas a close correlation was found between the serum concentration in the umbilical vein and artery. 3) The progesterone concentration of the maternal serum increased during the 28th-40th weeks, but increased only during 28th-36th week in the umbilical vein and artery and fell significantly by the 40th week. From this it appears that the maternal and the fetal progesterone concentrations are interdependent. The progesterone concentration of the umbilical vessels falls before term but it is not an essential factor in the onset of labor.

K cell activity is low in newborn infants.

K cell activity of 18 mature, healthy newborns was measured against O,Rh(D)-positive erythrocytes, sensitized by anti-D antibodies, in cord and venous blood (later obtained 3-4 days after delivery). 53 healthy women served as controls. Activity was determined as a function of target cell number in the enzyme-like kinetic model of cytotoxicity. It was low in cord blood, increased in venous blood by days 3-4 but it did not reach the level of adults. While cytotoxic activity of male infants increased significantly from birth to the 3rd-4th day of life, it did not change in female infants. No correlation was found between the weight and K cell activity of newborns.

Unconjugated 17 beta-oestradiol and oestriol in maternal serum and in cord vein and artery blood at term and preterm delivery.

The serum level of unconjugated 17 beta-oestradiol (E2) and oestriol (E3) in the maternal vein (MV), the umbilical vein (UV) and artery (UA) immediately after term (n = 34) and preterm (n = 74) labour was measured to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found. (1) The level of E2 and E3 increased equally in the MV, UV and UA serum from the 28th-32nd week to the 33rd-36th week of pregnancy. From the 33rd-36th week to the 40th week there was no change in the MV, but the value of E2 and E3 decreased significantly in the UV and UA serum. (2) The serum level of E2 in the MV was significantly higher than that in the UV and UA during every gestational period. In contrast, the serum concentration of E3 in the MV was significantly lower than that in the UV and UA. (3) The value of 'UA/UV X 100' of E2 and E3 was about 30% during the 28th-40th week. (4) A weak correlation was found between the MV serum level of E2 and E3 and UA serum concentrations. A strong correlation was found between the UV and UA serum levels of E2 and E3. The authors suggest that though there is a close connection between the fetal and the maternal organism, the fetus is still capable of maintaining its hormonal environment independently.

K-cell activity is enhanced intrapartum.

The cytotoxic activity of killer (K)-cells was measured against O Rh(D)-positive human erythrocytes sensitized by anti-D antibodies, in 14 women during normal labor and compared with the K-cell activity of 20 pregnant women (in the 37-40th week of pregnancy) and 42 non-pregnant female controls. K-cell activity was determined by the enzyme-like kinetic cytotoxic model, which measured the maximum of killing capacity. Cytotoxic activity was found to be significantly higher intrapartum. Data are compatible with the possibility that immunologic mechanism(s) are contributing to the onset of parturition.

Cytotoxic activity of peripheral mononuclear cells in normal pregnancy.

Killer-cell activity was studied in healthy pregnants in all three trimesters of pregnancy. Results were compared with values obtained three months after delivery, as well as with similar data of non-pregnant women. The effect of pregnant and non-pregnant sera on cytotoxic activity has also been investigated. Killer-cell activity was measured by a capacity test on antibody coated human red blood cells. According to the results, healthy pregnancy did not influence the maternal killer-cell activity. On the other hand, the various sera had a decreasing effect on the killer-cell activity of both pregnant and non-pregnant women. Attention is called to the aspecific inhibitory effect of sera.

Effect of enzaprost F on the dilatation of cervical canal following intracervical and extra-ovular application in the first trimester of pregnancy.

PIP: Primigravidas ranging in age from 14-24 years who presented themselves for lawful abortion in the 7th-12th week of pregnancy were distributed into 2 groups to examine whether Enzaprost F (Chinoin) may be used in form of intracervical tablet and extraovular solution for preoperative cervix dilatation in the 1st trimester of pregnancy. In 1 group (n = 210), 10 cervical tablets were introduced into the cervical canal under aseptic circumstances following vaginal exposure by using the ascending tube of Szontagh's IUD. The tablets contained in 200 cases 2.5 mg prostaglandin F2alpha (Pgf2alpha) each (Enzaprost F cervical tablet, Chinoin) and in 10 cases only carrier substance (placebo). The dilatation of cervical canal was measured by means of Hegar's dilators prior to the introduction of the PGF2alpha containing tablets in 80 cases, 2 hours subsequently in 111 cases, and 3-4 hours subsequently in 89 cases, directly before emptying the uterus. If the dilatation of cervical canal failed to reach 11 mm after the preoperative treatment this was dilated further with Hegar's dilators directly before emptying the uterus. In the placebo group the dilatation of cervical canal was measured by the same method before and 2 and 4 hours after the application of tablets. In the other group (n = 45), pregnant women were ranged who had 2nd grade purity of vagina due to previous local vaginal treatment. In the 7th-12th week of pregnancy, the effect of 10 Enzaprost F cervical tablets was observed to be a function of time. The average dilatation of cervical orifice was 5.0 mm before treatments. 2 hours after the application of PGF2alpha, the cervical canal was dilated to 6.9 and 3-4 hours later to 8.5 mm. In response to 1.0 Enzparost F solution containing 1.0 mg active substance injected into the uterus through Foley catheter the cervical canal dilated within 3 hours to in average 8.1 mm, within 18 hours to in average 10.9 mm. The dilatation of the cervical canal measured after 18 hours did not differ significantly from the value obtained after 3 hours. The dilatation of cervical canal measured before treatment in the group of placebo-treated primigravidas was in average 4.6 mm and in hours 2 and 4 of treatment 4.8 and 4.9 mm, respectively. The difference was statistically nonsignificant. Temporary mild systemic unwanted effect occurred in 35% of patients treated with Enzaprost F cervical tablets and in 88% of women subjected to extraovular treatment.^ieng

Episodic secretion of hormones and the diagnostic value of single blood estimates. II. Progesterone, oestradiol and oestrone.

The episodic fluctuation of serum progesterone, oestradiol and oestrone levels was studied. Progesterone was determined in the luteal phase, oestradiol and oestrone concentrations were measured in the proliferative and luteal phases in 8 subjects in 10 min intervals between 08 and 12 h a.m. Reliability criteria proved the radioimmunological methods used to be comparable to those employed routinely. The within-person fluctuation of hormone levels characterized by the coefficient of variation of single estimates averaged 20.16, 23.0 and 11.6% for progesterone, oestradiol and oestrone, respectively. The considerable fluctuation of hormone concentrations suggest the importance of hormone measurements to control luteal function and folliculogenesis during the menstrual cycle.