The impact of environmental and behavioural cofactors on the development of cervical disorders in HR-HPV-infected women in Serbia.

Persistent infection with one or more highly oncogenic human papillomaviruses (HPVs) or high-risk-HPV (HR-HPV) is necessary but not a sufficient aetiological agent for the development of cervical neoplasia. A number of viral, host, environmental and behavioural factors are suggested to be associated with the progression of cervical disorder. This study aimed to evaluate the impact of environmental and behavioural cofactors on the development of cervical disorders in HR-HPV-infected women in Serbia. A total of 541 women have been tested by PCR for the presence of HPV on the cervix. HPV genotypes were determined by direct DNA sequencing. Women identified as HR-HPV-positive were further classified into four subgroups according to their cytological status. All relevant information about demographical and behavioural factors was obtained by interviewer-based questionnaire. A number of analytical and descriptive statistical methods were used for processing the data. The cofactors found to be of significance for the progression of cervical disease were older age, body mass index >25, lower educational level, long-term smoking, previous genital infections and cervical interventions. On the other hand, condom use was found to have a protective role. Information about these cofactors might be very important for the development of more efficient cancer prevention programmes and promotion of anti-HPV vaccination.

Recurrent multiple endometrial polyposis in patient treated by antipsychotic drugs.

Irregular uterine bleeding and profuse menstrual bleeding often occur in patients treated by antipsychotics, antiepileptics, and some antihypertensive drugs. Such bleedings represent an important problem in clinical practice, especially when related to antipsychotic treatment. Nonetheless, this problem has not been often analyzed in references. This paper describes a recurrent multiple endometrial polyposis accompanied by profuse menstrual bleeding in a patient undergoing a multi-year treatment of bipolar affective disorder by antipsychotics and discusses the possibilities of prevention of irregular and profuse menstrual bleeding in patients that must use antipsychotic therapy in order to treat a psychiatric illness.

p16INK4a as an adjunct test in cervical cytology.

BACKGROUND: This study investigated the correlation between cervical cytology, the expression of P16INK4a, and human papilloma virus (HPV) infection. MATERIALS AND METHODS: The study included 100 subjects with suspected pathological cervical lesions. Cervical smears were analyzed for malignancy and p16INK4a. Histological finding represented "the golden standard". RESULTS: Immunocytochemical analysis of protein p16INK4a expression on epithelial cells of cervical smear demonstrated increased p16lNK4a expression in 36.0% of subjects. There was statistically significant positive correlation (Spearman r = 0.70; p < 0.001) between the pathological findings and the intensity of p16INK4a protein expression inside the epithelial cells, as well as with the histological finding (Spearman r = 0.71; p < 0.001). The intensity of p16INK4a protein expression in cytology finding was significantly higher in HPV16 positive patients (Mann- Whitney test, p = 0.0065). CONCLUSION: Good correlation between the expression rate and the severity of lesions indicates that this test might improve the results of cytology and HPV screening, as well as the results of predicting the prognosis of the disorder of the cervix.

Amelanotic malignant melanoma of the perineum: a case report.

The case of a patient diagnosed and surgically treated for amelanotic malignant melanoma of the perineum, accompanied by several local relapses, metastases to iliac-femoral lymph nodes, and distant metastases to both lungs is presented. Survival, up to date, equals 12 years. Amelanotic malignant melanomas are very rare tumors. Perineal and perianal localization of these tumors is especially rare. References cite about 500 cases with survival limited to between six months and one year after diagnosis..

Cervical conization--treatment for cervical intraepithelial neoplasia and carcinoma in situ.

PURPOSE: Cone biopsy is the best treatment for high-grade premalignant cervical changes. Cervical intraepithelial changes do not show any clinical picture until the process develops into carcinoma. METHOD: This retrospective study included 395 women who underwent conization at Gynecology and Obstetrics Clinic "Narodni front" during 2009. The chi-square test was used for comparing results. RESULTS: Pathohistological findings from biospy and conization were identical in 40.50% of patients, in 10.13%, the conization finding was more severe than the biopsy finding, while in 49.37% less severe than the biopsy finding. Resection margins status analysis showed that 12.66% of cones were positive. Comparison between cones with positive margins and operative techniques did not show any statistically significant difference; 64% of women with positive margins were over the age of 35. CONCLUSION: Operative conization techniques are equally represented. However in women over the age of 40 scalpel excision methods are recommended. In women over the age of 45 there is a statistically significant increase in the risk for positive resection margin with CIN3 and glandular lesions.

Rare metastases of carcinoma of uterine cervix.

This paper describes a case of cancer of the uterine cervix metastasizing in the spleen two years after the primary carcinoma was diagnosed and treated. After detailed diagnostics, the patient was subjected to surgery. Histopathological examination after splenectomy confirmed a very rare case - presence of metastases of planocellular carcinoma of the uterine cervix. Over the last ten years, references cite isolated cases of metastases of adenocarcinoma of the colon, stomach and breast in the spleen as well as lung carcinoma and malignant skin melanoma. Until now cases of uterine cervix carcinoma metastasizing to the spleen have been published as micrometastases detected in autopsy material.

Invasive inflammatory pseudotumor of the pelvis: a case report with review of the literature.

Inflammatory pseudotumor (IPT) is a rare benign lesion of unknown etiology, which mimics malignant neoplasm and may arise from various organs. A 53-year-old woman was submitted to diagnostic evaluation because of bilateral, hydroureteronephrosis and oedema of the left leg after a 3-month history of fever of unknown origin. On bimanual vaginal and rectal examination, a mass was involving the uterus, parametria and mostly left adnexa, while the cervix appeared normal. Computed tomographic (CT) scan revealed a 13x10.5 cm mass in the pelvis, mostly at the place of the left adnexa, uterus and both parametria, also involving the surrounding tissues and producing bilateral hydroureteronephrosis. At laparotomy, a grey solid mass was seen, mainly involving the reproductive system. As no radical operation could be performed, the mass was only biopsied and histology showed an inflammatory pseudotumor. Antibiotic therapy was given for one month. Follow-up CT 4 and 8 months after laparotomy showed local regression of IPT. The last follow-up CT, 20 months after laparotomy, revealed no evidence of tumor.

[Dilemmas and opinions on the diagnosis and surgical treatment of injuries of the knee meniscus]. / Dileme i stavovi u dijagnostici i kirurskoj terapiji ozljeda meniskusa koljena.

Authors describe their opinion and dilemma in the diagnosis and surgical treatment injuries of the knee meniscus during period of the ten years. In diagnostic dilemma at doubtful signs of the meniscus tear they pointed out roentgenographic investigation as arthrography of the knee joint by double contrast method which was tasted method in 92.9% cases. In surgical treatment they mention experiences in 271 meniscectomy. They made 14.7% partial meniscectomies and 85.3% total meniscectomies. In dilemma total or partial meniscectomy structures of the knee joint are less injured, postoperative rehabilitation is better and shorter and degenerative change are in frequency only 5% in their material. They prefer early meniscectomy, because the late results with this method are only excellent. They pointed out importance good postoperative rehabilitation, which together with good diagnostic, early and regular surgical treatment is undivided complete in the successful treatment tears of the knee meniscus.