RESUMO
This is a retrospective case series conducted in Worthing General Hospital to evaluate the clinical outcome of abdominal vault suspension (AVS) using rectus sheath strips to treat vaginal vault prolapse. Thirty-four patients had suspension of the vaginal vault using this procedure. Patients were followed up at 3-6 months and by questionnaire for up to 90 months. Incidence of intraoperative and postoperative complications, improvement of prolapsed symptoms and recurrence of vault prolapsed were the main outcome measures. There were no serious intraoperative complications. Ninety four percent of patients had subjective resolution of their prolapsed symptoms whereas 6% had further symptoms. Hospital stay ranged from 2 to 8 days. There were no cases of bowel problems in the postoperative period or in the long term. Hospital stay ranged from 2 to 8 days. AVS using rectus sheath strips appears to be a safer and easier alternative to other abdominal suspension procedures. The use of patients' own tissue eliminates the risk of mesh erosion.
Assuntos
Reto do Abdome/transplante , Prolapso Uterino/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Complicações do Trabalho de Parto , Retocele/etiologia , Feminino , Humanos , Gravidez , Fatores de Risco , Aumento de PesoAssuntos
Doença da Hemoglobina SC/complicações , Hipóxia-Isquemia Encefálica/complicações , Microcefalia/etiologia , Complicações Hematológicas na Gravidez/terapia , Adulto , Cardiotocografia/métodos , Evolução Fatal , Feminino , Doença da Hemoglobina SC/terapia , Humanos , Lactente , Masculino , Gravidez , Resultado da GravidezAssuntos
Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Dissecção Aórtica/complicações , Dissecção Aórtica/cirurgia , Cesárea , Isquemia/etiologia , Perna (Membro)/irrigação sanguínea , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Prótese Vascular , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Terceiro Trimestre da Gravidez , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
Perinatal transmission of genital human papillomaviruses (HPVs), including HPV-16 and -18 which are associated with anogenital carcinomas have been described previously [Pakarian et al. (1994): British Journal of Obstetrics and Gynaecology 101:514-517; Kaye et al. (1994) Journal of Medical Virology 44:415-421]. A study was undertaken to investigate whether HPV-16 and -18 DNA in infants contaminated at delivery persists until they are 6 months of age. Of 61 pregnant women recruited, 42 (68.8%) were HPV-16 and 13 (21.3%) were HPV-18 DNA positive. At 24 hr there were transmission rates from HPV DNA positive mothers to their infants of about 73% (HPV-16: 69%; HPV-18: 76.9%). Ten mothers who were both HPV-16 and -18 DNA positive produced six (60%) infants who were also doubly positive at 24 hr. HPV DNA persisted to 6 weeks in 79.5% (HPV-16: 84%; HPV-18: 75%) of those infants who were positive at birth. At 6 months of age, persistent HPV-16 DNA was detected in 83.3% of cases, but HPV-18 DNA persistence at this time was 20%. To extend these observations over a greater age range of children HPV-16 L1 and L2 proteins were expressed in insect cells via recombinant baculoviruses and sera from 229 children were examined to determine at what age IgM antibodies to HPV were acquired. There was a bimodal distribution of IgM seropositivity which peaked between 2 and 5 and 13 and 16 years of age, suggesting that two distinct modes of transmission may occur. The observation that infection with high cancer risk genital HPVs may occur in early life and persist is of considerable importance for HPV vaccine strategies.
Assuntos
Papillomaviridae , Infecções por Papillomavirus/virologia , Infecções Tumorais por Vírus/virologia , Adolescente , Adulto , Animais , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Antígenos Virais/genética , Antígenos Virais/imunologia , Capsídeo/imunologia , Linhagem Celular , Criança , Pré-Escolar , DNA Viral/sangue , Feminino , Células HeLa , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Masculino , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/sangue , Infecções por Papillomavirus/transmissão , Gravidez , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/imunologia , Infecções Tumorais por Vírus/sangue , Infecções Tumorais por Vírus/transmissãoAssuntos
Papillomaviridae , Infecções por Papillomavirus/transmissão , Complicações Infecciosas na Gravidez , Infecções Tumorais por Vírus/transmissão , Adolescente , Anticorpos Antivirais/sangue , Parto Obstétrico , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Papillomaviridae/imunologia , Infecções por Papillomavirus/imunologia , Gravidez , Projetos de Pesquisa , Infecções Tumorais por Vírus/imunologiaRESUMO
A 77-year-old woman presented with an abdominal swelling and underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy for a left ovarian tumor. This was an ovarian mature cystic teratoma in which had developed a sebaceous cell carcinoma. This is a rare form of ovarian malignancy whose behavior is poorly documented. The treatment and follow-up of this case are discussed.
RESUMO
Whilst genital papillomaviruses are commonly believed to be sexually transmitted, transmission of human papillomavirus type 16 (HPV-16) from mother to child at delivery has been described previously [Pakarian et al. (in press) British Journal of Obstetrics and Gynaecology]. In order to determine whether viral load in cervical/vaginal cells was an important determinant of transmission 15 pregnant women with HPV-16 infections were studied. Eight of these women had infants who were positive for HPV-16 DNA at genital and/or buccal sites. Viral load was estimated by laser densitometry of polymerase chain reaction (PCR) products. The eight mothers--four with a previous history of abnormal smears and two with previous genital warts--who transmitted infection to their infants had significantly higher viral loads (P < 0.05) than those who did not. It is concluded that viral load is an important, but not the sole, determinant for the transmission of HPV-16 from mother to infant.
Assuntos
Genitália Feminina/virologia , Transmissão Vertical de Doenças Infecciosas , Papillomaviridae , Infecções por Papillomavirus/transmissão , Infecções Tumorais por Vírus/transmissão , Adolescente , Adulto , Sequência de Bases , Feminino , Globinas , Humanos , Lactente , Recém-Nascido , Dados de Sequência Molecular , Infecções por Papillomavirus/virologia , Infecções Tumorais por Vírus/virologiaRESUMO
Polyclonal antibodies were raised to partial and full-length synthetic peptides of human papillomavirus type 16 (HPV-16) E5. Antisera specificity for HPV-16 E5 was demonstrated by their ability to recognize not only their peptide immunogens but also full-length peptide and a glutathione S-transferase-E5 fusion protein. The most reactive antiserum, PE-6, raised to a full-length peptide, was used in Western blot analysis to identify HPV-16 E5 protein from exfoliated cervical cells. A strong, single band at approximately 20K was detected in two of six HPV-16-positive samples from women with a history of low-grade cervical intraepithelial neoplasia. The apparent M(r) by SDS-PAGE suggests that HPV-16 E5 forms homodimers in vivo, but not through cysteine linkage.
Assuntos
Colo do Útero/virologia , Proteínas Oncogênicas Virais/análise , Papillomaviridae/isolamento & purificação , Proteínas Repressoras , Anticorpos Antivirais , Western Blotting , Eletroforese em Gel de Poliacrilamida/métodos , Feminino , Glutationa Transferase/análise , Glutationa Transferase/biossíntese , Glutationa Transferase/imunologia , Humanos , Proteínas Oncogênicas Virais/biossíntese , Proteínas Oncogênicas Virais/imunologia , Papillomaviridae/imunologia , Peptídeos/síntese química , Peptídeos/imunologia , Proteínas Recombinantes de Fusão/análise , Proteínas Recombinantes de Fusão/biossíntese , Proteínas Recombinantes de Fusão/imunologia , Esfregaço VaginalAssuntos
Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Infecções Tumorais por Vírus/virologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Sequência de Bases , Primers do DNA/genética , DNA Viral/genética , Feminino , Humanos , Recém-Nascido , Troca Materno-Fetal , Dados de Sequência Molecular , Papillomaviridae/classificação , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/transmissão , Reação em Cadeia da Polimerase , Gravidez , Complicações Infecciosas na Gravidez/virologia , Infecções Tumorais por Vírus/complicações , Infecções Tumorais por Vírus/transmissão , Integração Viral/genéticaRESUMO
OBJECTIVE: To demonstrate the perinatal transmission and persistence of the cancer associated human papillomavirus types 16, 18, 31 and 33. DESIGN: Cervical swabs were taken from pregnant women between 20 and 38 weeks of gestation. Buccal and genital swabs were taken from infants at 24 h and at six weeks after delivery and examined for HPV-16, -18, -31 and -33 DNA by the polymerase chain reaction. SETTING: Maternity Unit at St Thomas's Hospital, London. SUBJECTS: Thirty-one pregnant women, 16 with a previous history of cervical intraepithelial neoplasia or genital warts, or both, and their 32 infants (one set of twins). RESULTS: Twenty of the 31 (65%) women were positive for HPV-DNA prior to delivery. Twelve of 32 (38%) and eight of 31 (26%) infants were HPV-DNA positive at 24 h and six weeks respectively. Swabs taken at 24 h demonstrated HPV type 16 in five mother-infant pairs and HPV type 18 in two mother-infant pairs. Dual infections with HPV types 16 and 18 were demonstrated in swabs from three mother-infant pairs. At six weeks, HPV-16 was demonstrated in swabs from six infants and HPV-18 in swabs from two infants. CONCLUSIONS: Perinatal transmission of human papillomavirus types 16 and 18 occurred in 55% cases. Persistent human papillomavirus infection was demonstrated at six weeks of age. Whether acquisition of human papillomavirus during the perinatal period predisposes to an increased risk of cervical intraepithelial neoplasia among female infants in later life remains to be established. Information on the persistence of perinatally acquired human papillomavirus is required before rational vaccination programmes can be considered.