Granzyme B as a prognostic marker of cervical intraepithelial neoplasia.

Granzyme B (GrB) is a serine protease synthesized in T lympocytes (CTL), released after T-cell activation resulting from exogenous stimulation. With perforin, GrB discharges apoptotic signals to a target cell and therefore constitutes a marker to identify activated CTL. We aimed to quantify GrB expression by immunohistochemistry staining in 12 tissue fragments of cervical carcinoma, 33 cervical intraepithelial neoplasias treated by LLTEZ and nine cervical pieces without disease. Activated cytotoxic lymphocyte mean values (20 HPF-400x) in both epithelial and stromal pars were 7.11 cells in tissue without neoplasia, 33.45 cells in cervical intraepithelial neoplasia and 139.75 cells in carcinoma samples, with a statistical difference between them. Comparative analysis in the CIN group showed an expressive difference between cases with disease recurrence (19.28 cells) and without recurrence (37.26 cells). Thus, the relation between number of activated CTLs found at the moment of treatment and clinical evolution determined in this study, suggest GrB use as a prognostic marker.

Relationship between angiogenesis and grade of histologic differentiation in endometrial adenocarcinoma.

The objective of the study was to quantify vessels and to relate them to the degree of histologic differentiation in endometrial adenocarcinoma. We studied 35 cases of which ten were G1, 13 G2 and 12 G3 adenocarcinomas. The control group consisted of 11 atrophic and 10 proliferative endometria. From each case two histologic sections were obtained: one for hematoxylin-eosin staining and the other for immunohistochemical study with anti-CD34. Vessel count was performed by morphometric study. Mean vessel count was 15.3 for G1; 19 for G2 and 22.7 for G3 adenocarcinomas; in the control group it was 11.6 for atrophic and 13.2 for proliferative endometria. Slightly differentiated adenocarcinoma presented greater angiogenesis than normal and well-differentiated carcinoma. In contrast, moderately differentiated carcinoma showed greater angiogenicity as related to normal endometrium, but did not differ from other tumoral endometria.

Low-dose 5-fluorouracil adjuvant in laser therapy for HPV lesions in immunosuppressed patients and cases of difficult control.

The authors established a protocol for the use of 5-fluorouracil (5FU) adjuvant in lasertherapy for clinical and subclinical HPV infection in immunosuppressed patients, persistent lesions and as reinforcement treatment in cases of poor progress. Sixty-four patients were evaluated, of whom 26 were immunosuppressed, 34 presented persistent lesions and four received intravaginal reinforcement treatment with 2.5 g 5% 5FU every two weeks, or biweekly vulvar reinforcement after lasertherapy. On average, five 5FU courses were used, but in the immunossuppressed patients its use was maintained indefinitely. The rate of complete response was 66%, but the immunossuppressed patients showed less response (46.2%) when compared with the persistent lesion/reinforcement treatment group (78.9%). The responses were positive in the two groups when compared to that with no response. We deem the use of low-dose 5FU an excellent alternative in cases of difficult HPV progress, presenting a low cost and minimal side-effects.

Evaluation of Langerhans' cells in human papillomavirus-associated squamous intraepithelial lesions of the uterine cervix.

Current research has been evaluating morphological modifications and density of Langerhans' cells in women with histopathological HPV lesions of the uterine cervix. Fourteen women with subclinical HPV infections underwent clinical, colpocytological colposcopy examinations, and paired biopsies of the uterine cervix. Histopathological, HPV hybrid capture and S-100 immunohistochemical examinations were performed in biopsy specimens. Groupings of viral lesions and normal tissue were analyzed by the Wilcoxon rank-sum test. Langerhans' cells in the specimens were frequently located in the intermediate and basal layers of the epithelium. A significant reduction of cytoplasmic profiles occurred in viral lesions (144.08 profiles/mm2) when compared to normal tissue (256.27 profiles/mm2) of the epithelium. An inverse modulation occurred in the cytoplasmatic profiles/nuclei ratio with 2.80 in viral lesions and 4.89 in normal tissue of the stroma. A local immunodeficiency based on cytoplasmic changes of Langerhans' cells has been postulated as a mechanism by which HPV could be involved in the genesis of neoplasia.

P27 expression in normal epithelium and condylomas of the vulva in HIV positive and negative women.

PURPOSE: The objective of the present study was to evaluate the expression of the p27 protein in the normal epithelium and vulvar condylomas in human immunodeficiency (HIV) positive and negative patients. METHODS: Eight samples of normal vulvar epithelium were evaluated (Group A), ten of the HIV negative vulvar condyloma patients (Group B) and another eight of the vulvar condyloma HIV positive patients (Group C). The DNA of human papillomavirus (HPV) was identified by means of polymerase chain reaction (PCR). Immunohistochemistry was the method used to evaluate the expression of p27 using monoclonal mouse antibody (Monoclonal Mouse, anti-human p27, Clone Sx 53 G8). The immunoexpression was evaluated at a magnification of 400x, counting a minimum of 1,000 cells per slide. RESULTS: The results obtained were the following: a) comparing groups A and B and groups A and C there was a significant difference in relation to the expression of the p27 protein which was 63.32% in group A and only 13.35% and 18.89% in groups B and C, respectively; b) comparing groups B and C among them, there was no significant difference. CONCLUSION: We concluded that in normal vulvar tissue the p27 protein is present in a large number of cells and that in vulval condylomas its expression is very much lowered both in HIV positive and negative cases.

Histologic and biomolecular aspects of papillomatosis of the vulvar vestibule in relation to human papillomavirus.

OBJECTIVE: To determine whether human papillomavirus (HPV) plays a role in the genesis of papillomatosis of the vulvar vestibule. METHODS: We conducted a study based on molecular hybridization and histology of biopsy material obtained from the inner surface of the labia minora of 25 women with papillomatosis of the vulvar vestibule who presented no abnormal clinical, cytologic, or colposcopic changes in the cervix or vagina. These women were compared with 24 women with condyloma acuminatum of the vulvar vestibule and with ten women with normal vulvar epithelium and no cervicovaginal changes. All patients included in the study were 35 years or younger, and none was pregnant. RESULTS: Papillomatosis of the vulvar vestibule was rarely found to be HPV positive by molecular hybridization (one of 25, 4%, by dot blot hybridization and one of 15, 6.67%, by polymerase chain reaction [PCR]). This result did not differ significantly from that obtained for the group with normal vulvar epithelium (none of 10 by dot blot and none of six by PCR), but did differ (P = .001) from the result obtained for the group with condyloma acuminatum of the vestibule (12 of 24, 50%, by dot blot and six of six, 100%, by PCR). The biomolecular study of vestibular papillomatosis showed that focal koilocytosis was not correlated with HPV infection. CONCLUSION: Papillomatosis of the vulvar vestibule is not associated with HPV and should be considered a paraphysiologic formation of the vulvar epithelium. The diagnosis of vulvar HPV infection should be avoided in the absence of more explicit clinical-histologic evidence, with no need for biopsies or unnecessary treatments.

[Heparin effect on prevention of pelvic adhesions. Experimental study]. / Efeito da heparina na prevenção de aderências pélvicas. Estudo experimental.

Thirty-one mongrel female dogs were submitted to a standard lesion on the right uterine horn, consisting of crushing, scratching, and ischemia of the segment. Three groups were formed for the study: control group (GC), experimental group I (G1), and experimental group II (G2). In GC, continuous washing with simple ringer solution was applied during surgery. In G1, heparin was added to the ringer solution at a doses of 100 IU/kg. In G2, in addition to the heparin diluted in the ringer solution, subcutaneous heparin was given at 12 hours intervals for three days, at a doses of 100 IU/kg/doses. The percentage of dogs with pelvic adhesions was determined by laparotomy. Adhesion intensity in the incision and in the pelvis was determined. 100% of dogs in G2 had adhesions in the incision, whereas 66.66% had incision adhesion in GC. There was no statistical difference. All groups presented around 50% of pelvic adhesions. Intensity of pelvic adhesions was not different in the three groups, but G2 had more adhesions than GC, such difference being statistically significant.

[Treatment of human papillomavirus infection of the uterine cervix with gel interferon]. / Tratamento da infecção do colo uterino por papilomavírus humano com interferon gel.

Treatment of uterine cervix infection caused by human papillomavirus still is an enigma. Some drugs have been tested with cure rates between 60 to 70%. Most of such agents are substances which produce a strong epithelial desquamation and have shown strictly toxic side effects. The use of interferon in this infection has been studied, but different authors disagree in their therapeutic findings. A randomized, double blind trial was conducted to compare interferon to placebo. Preliminary results are presented in this article. 47 patients were followed so far. 18 of them were evaluated and the results are shown in this article.

[Diagnosis of cervicovaginal infection by human papillomavirus. Value of colposcopy, cytology and histopathology as methods of diagnosis]. / Diagnóstico da infecção cervicovaginal por papilomavírus humanos. Valor da colposcopia, citologia e da histopathologia como métodos diagnósticos.

The authors evaluated 476 patients to determine the accuracy of colposcopy, cytology, and histopathology as diagnostic methods for cervical and vaginal HPV infections. Results were treated by statistical analysis which showed significant disagreement among the methods tested. Colposcopy was positive in 87.8% of the cases. Abnormal transformation zone was the most frequent finding in the cervix, acetowhite epithelium being its main representative. Condylomatous vaginitis was the most frequent feature in the vaginal surface. Cytology was positive in 76.9% of the cases. To increase sensitivity of this method, the authors suggest that not only koilocytosis is important, but other major aspects are also important, such as minimal koilocytosis, dyskeratosis, karyopyknosis, binucleation, and multinucleation. Histopathology was positive in 81.9% of the cases. In conclusion, the three diagnostic methods studied presented statistical disagreement, however, they are supplementary and efficient.

Aderências em microcirurgia tubária / Adhesions in tubal microsurgery

No Setor de Reproduçäo Humana da Disciplina de Ginecologia da Escola Paulista de Medicina os AA. avaliam os resultados de microcirurgia tubária em 202 pacientes, com e sem uso de Dextran 70%. Nos 202 casos referem permeabilizaçäo tubária em 90% dos casos. As taxas de gravidez pós-cirúrgicas foram de 27% no grupo sem o uso de Dextran e de 33,9% naqueles em que essa soluçäo glicosada foi utilizada. Concluem afirmando ser o uso do Dextran 70 útil para reduzir as aderências tubárias pós-operatórias

Microcirurgia tubária na clínica ginecológica da Escola Paulista de Medicina / Tubal microsurgery at the gynecologic clinic of the Escola Paulista de Medicina

Os AA avaliaram o resultado da microcirurgia tubária em 196 casos operados na Clínica Ginecológica da Escola Paulista de Medicina, no período de 10 anos; de 1978 a 1987. Separam os casos de acordo com o tipo de cirurgia em Salpingostomia: 52 vezes; lise de aderências (salpingolise): 48; anastomose ístmico ístmica: 62 e reimplante tubo-uterino: 34. Descrevem as técnicas e concluem expondo seus resultados em termos de permeabilizaçäo e de gravidez. Afirmam que cerca de 25% dos casos resultam em gestaçäo, na média de todos os casos e especificam as porcentagens de cada tipo de cirurgia realizada

[Prevention of gynecological cancer: Socioeconomic, colposcopic and cyto-histological study].

PIP: Study of 600 patients at the Service for the Prevention of Gynecological Cancer of a maternity hospital in Brazil resulted in a correlation between socioeconomic conditions and the findings of routine examinations for cancer prevention (cytology, colposcopy, and histology). Positive findings of neoplasia were obtained in 7 cases, a much higher incidence than that found in the population generally. It is concluded that the greater incidence of cervical cancer is the result of socioeconomic conditions, such as early beginning of sexual relations (116 patients, i.e., 19.3%, began their sexual life before age 15), promiscuity, multiparity, and early pregnancies, which were found very frequently in the population studied. These findings confirm those reported by other authors.^ieng