Profile of maternal smokers and their pregnancy outcomes in south western Sydney.

OBJECTIVE: The prevalence of maternal smoking remains high in New South Wales. In order to better understand the profile of maternal smokers, a study has been conducted to examine the social and demographic characteristics and pregnancy outcomes of women who smoked during their pregnancy in south western Sydney. METHODS: Women and babies of a retrospective cohort of 7,191 singleton births between March 1996 and December 1998, at Liverpool Hospital were analyzed. RESULTS: The prevalence of maternal smoking for the study population was 18.8%. The study found that the sociodemographic factors, such as marital status, ethnic origin, English speaking background, working status during pregnancy, and private health insurance status were independent risk factors for maternal smoking, but maternal age was not. Women who smoked during their pregnancy had higher rates of abruptio placenta, threatened premature labour, and premature labour. The adverse neonatal outcomes due to maternal smoking were low birth weight and increased neonatal morbidity. Smoking appears to have a protective effect on pregnancy induced hypertension. CONCLUSION: The findings of this study suggests that future smoking cessation programs should pay more attention to addressing sociodemographic and cultural factors that influence the behaviour of maternal smokers.

Learning group: facilitating the adaptation of new nurses to the specialty unit.

BACKGROUND: The nursing shortage creates major problems in finding qualified, experienced nurses in the critical care area. METHOD: A learning group was formed to expedite the new nurses' acquisition of skills and knowledge needed to care for critical care patients. RESULTS: After 4 months of continuing education provided in the learning group, all group members had demonstrated their interest in learning. They also had demonstrated they were able to perform different procedures and skills according to the standards listed in the trauma intensive care unit nurses' manual. CONCLUSION: The learning group is able to facilitate quicker adaptation and smoother transition of new nurses to the trauma intensive care unit. The continuing education provided by the learning group demonstrated support from the workplace and peers to the new nurses.

The oral health of children with clefts--a review.

A review of the studies of the caries prevalence and periodontal health of patients with cleft lip and palate (CLP) revealed that only five investigations of caries prevalence in CLP patients included children. One reported that CLP children did not have a higher caries prevalence in the permanent dentition, whereas more recent studies have reported a higher caries prevalence in both the primary and permanent dentitions of CLP children than in those of noncleft children. However, there is wide variation in the teeth examined and the method of presenting data on caries prevalence. Six papers have reported on the periodontal health of adult CLP patients, and only one has done so on that of children. The adult CLP patients had poorer oral hygiene and more gingivitis, but there is no conclusive evidence that they have a higher risk of developing periodontal disease. No data on the oral hygiene of CLP children were available, but it has been emphasized that they have significantly more gingivitis than noncleft children, especially in the maxillary anterior teeth.

Resistance to carbon tetrachloride-induced hepatotoxicity in mice which lack CYP2E1 expression.

CYP2E1 knockout mice (cyp2e1-/-) were used to investigate the involvement of CYP2E1 in the development of carbon tetrachloride (CCl4)-induced hepatotoxicity. Male cyp2e1-/- and wild-type (cyp2e1+/+) mice were given a single i.p. injection of 1 ml/kg (= 1.59 g/kg) CCl4 and 24 h later liver injury was assessed by elevations of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities and histopathology. No significant increases in serum ALT and AST activities were observed in cyp2e1-/- mice when compared to wild-type counterparts after CCl4 exposure. No detectable abnormality in liver histology was found in cyp2e1-/- mice after CCl4 exposure. In contrast, CCl4 treatment resulted in 442- and 125-fold increases in serum ALT and AST activities, respectively, in wild-type mice. Consistent with the results of serum ALT and AST activities, severe hepatic damage was noted in livers of wild-type mice, indicating the importance of CYP2E1 in mediating the hepatic damage following CCl4 exposure in these mice. In addition, a dramatic decrease in CYP2E1-catalyzed p-nitrophenol activity and complete loss of immunoreactive CYP2E1 were observed in wild-type mice after CCl4 treatment, suggesting that CYP2E1 was degraded during the process of CCl4-induced hepatotoxicity. These studies conclusively demonstrate that CYP2E1 is the major factor involved in the CCl4-induced hepatotoxicity in mice.

Massive ovarian oedema: 3 cases and clinical considerations.

Three cases (2 of which presented with torsion) of massive ovarian oedema occurring in young women, clinically suspected to be a neoplasm, are presented. Microscopic examination of each showed diffuse interstitial oedema and multiple cysts, some surrounded by luteinized cells. As the patients are young, we advocate conservative management with sparing of reproductive capacity, although that is not what happened with any of our 3 patients.

Human papillomavirus infection in Hong Kong Chinese women with normal and abnormal cervix--detection by polymerase chain reaction method on cervical scrapes.

Detection of human papillomavirus (HPV) was accomplished by utilizing polymerase chain reaction methods on cervical scrapes from a total of 488 Hong Kong Chinese women attending the colposcopy, general, and antenatal clinics. From colposcopy clinic, 10% of normal cervix, 31% of condyloma, 56, 50, and 57% of CIN I, CIN II, and CIN III, respectively, and 88% of squamous cell carcinoma contain HPV. The overall detection rate is 30%. The most prevalent type is 16. Four percent of scrapes from normal cervix of patients attending general gynecology clinic and none from antenatal clinic show HPV. The detection rate appears to be more related to the types of cervical lesions than to the age of the patients.

Oestrogen and progesterone receptors in normal human endometrium: comparison of immunocytochemical analysis on frozen and paraffin sections with or without enzymatic pretreatment.

Immunocytochemical study in paraffin sections of human endometrium showed that the receptor contents for both oestrogen and progesterone receptors were lower than in the frozen sections although the staining patterns were similar in these two section types. Pretreating the specimens with proteolytic enzymes like trypsin, DNase and pronase improved the oestrogen receptor staining but a better result with progesterone receptor staining was obtained when no enzymatic pretreatment was applied to the sections.

Ki67 and AgNORs staining in squamous cell carcinoma of the cervix: a comparison.

Ki67 immunostaining was performed on 48 cases of squamous cell carcinoma of the cervix and AgNOR silver staining on 29 cases. There was no correlation between the clinical stage of the tumor and the two methods of staining but both methods correlated with histological grade. There was no correlation between the two methods of staining in 17 case where they were done on adjacent blocks of tumor tissue. High Ki67 score but not high AgNOR count was significantly associated with early recurrence.

Immunohistochemical detection of proliferating tumor cells in cervical cancer using monoclonal antibody Ki-67.

Monoclonal antibody Ki-67 identifies cells in G1, S, G2, and M phases of the cell cycle. In this cytokinetic study, Ki-67 was used to characterize tumor cells in human cervical cancer specimen. This immunohistochemical study showed that Ki-67 staining gave a brown nuclear reactivity dispersed heterogeneously in a tumor cell population and correlated well with the mitotic activities of tumor cells. The finding suggested that Ki-67 staining provides an easily countable index for the study of proliferating cell populations in cervical cancer.

Study of oestrogen and progesterone receptors in normal human endometrium during the menstrual cycle by immunocytochemical analysis.

Monoclonal antibodies to human oestrogen and progesterone receptors were applied to frozen sections of normal endometrium in various phases of the menstrual cycle. Both oestrogen and progesterone receptors were localised within the nuclei of target cells. There are no oestrogen or progesterone receptors in endometrial vessels. Oestrogen receptor contents remained fairly constant during the proliferative and early secretory phases but decreased markedly in the late secretory phase. This decline was more obvious in the glandular cells than in the stromal cells, where receptor staining disappeared in most cases. The receptors were localised predominantly in the glandular cells at most stages of the menstrual cycle except in the late secretory phase, where the reverse was observed. In contrast, progesterone receptors rose gradually throughout the proliferative and early secretory phases followed by a decrease to various degrees depending on the cell types in the late secretory phase. This decrease was more marked in the glandular cells where again receptor staining disappeared in most cases, whereas the receptor contents in the stromal cells only decreased to the level of the late proliferative phase. The progesterone receptors were also localised predominantly in the glandular cells at most stages in the cycle apart from the late secretory phase.

Biological characteristics of a newly established human cervical carcinoma cell line.

A new cell line, designated CC2/CUHK2, was established from a squamous carcinoma of the uterine cervix from a Chinese patient. The cell line grew well without interruption for over 12 months and over 90 passages. The doubling time of CC2/CUHK2 was 72 hours at passage 57. When seeded at a density of 1.5 x 10(3) cells per 25 cm2 tissues culture flask, the plating efficiency was 2.15%. Chromosome analysis showed a range of 30 to 130 with a modal number of 75. Immunoperoxidase staining of keratin showed positive reaction. Most of the CC2/CUHK2 cells showed weak nuclear staining of HPV capsid antigens with the ABC detection system. Analysis of the DNA samples extracted from the cervical cancer cells showed the presence of HPV type 16 DNA.

Serum ceruloplasmin, plasma copper concentration and copper to ceruloplasmin ratio in cervical carcinoma.

Several studies have shown that plasma/serum copper and ceruloplasmin concentrations are increased in various carcinomas. We determined serum concentrations of ceruloplasmin and plasma copper concentration to evaluate the clinical usefulness of these tests in patients with cervical carcinomas. There was a significantly higher ceruloplasmin concentration in patients with cervical carcinoma compared to healthy controls. Plasma concentrations of copper were not significantly different in the two groups of subjects. The copper to ceruloplasmin ratio was lower in cancer patients than in control subjects. There was a significant increase in the serum concentrations of ceruloplasmin with increasing FIGO stage of cancer. Copper concentration in advanced tumours (FIGO stage 3) were significantly higher compared to control subjects or FIGO 1 and 2. Copper to ceruloplasmin ratio was lower in FIGO stage 2 and 3 patients compared to stage 1 or control subjects. Ceruloplasmin can also discriminate between large tumours which are inoperable and early cervical carcinomas better than copper or copper to ceruloplasmin ratio.

Genetic lesion in the carcinogenesis of cervical cancer.

Allelic loss at specific chromosomal loci was demonstrated in carcinoma of the cervix (CaCx) obtained from Hong Kong Chinese by restriction fragment length polymorphism analysis. Altogether 12 patients with CaCx, 7 with cervical intraepithelial neoplasia (CIN) and 7 with normal cervical tissues were studied. Polymorphic DNA markers for chromosome 3 were used and the tumour and constitutional genotypes of the above patients were compared. Loss of heterozygosity (LOH) was found in 10 out of 12 informative cases with CaCx at RAF-1 locus (3p25) and in 10 out of 11 cases at D3S3 (3p14). Further study on patients with cervical intraepithelial neoplasia showed LOH at both 3p25 and 3p14 in four out of five cases. In normal cervical tissues, no LOH was demonstrated at both loci. Our data suggest that the deletion events occurring on the short arm of chromosome 3 at 3p25 and 3p14 are early events in the development of carcinoma of cervix. Since recessive genes have been reported to reside within or close to these 2 loci, important genes may have been lost or inactivated in the genesis of this tumour. Moreover, human papillomavirus (HPV) type 16, 18 or 33 was found in 8/12 of the carcinomas and 4/7 of CIN using Polymerase Chain Reaction and/or Southern Blot hybridization, confirming the close association with human papillomavirus. Whether the observed genetic lesions in the short arm of chromosome 3 in cervical "premalignant" and malignant lesions and their consistent association with high risk HPV represent independent events in the development of carcinoma of cervix will be discussed.

Diffuse uterine leiomyomatosis with hemorrhage.

A 28-year-old woman with primary infertility and severe menorrhagia underwent a hysterectomy after failed hormonal therapy for multiple leiomyomas. The postoperative pathologic findings established the diagnosis of diffuse uterine leiomyomatosis, which demonstrated histologic, immunohistochemical, and ultrastructural similarity to leiomyomas of the uterus. The rapid growth of the tumor coincided with the administration of clomiphene citrate, an estrogenic agonist. As with the common leiomyoma, intralesional hemorrhage in this case of diffuse leiomyomatosis was associated with norethindrone acetate treatment given after the cessation of clomiphene therapy.

Uterine leiomyosarcoma diagnosed during treatment with agonist of luteinizing hormone-releasing hormone for presumed uterine fibroid.

Medical treatment with an LH-RH agonist may be used in selected cases of uterine fibroids. Although rare, rapid increase in uterine or fibroid volume may suggest an underlying leiomyosarcoma that would require prompt surgical intervention. Close monitoring of the response to treatment with an LH-RH agonist is essential.

Integration of HPV-16 DNA in cervical carcinoma cell line CC3/CUHK3 and its xenografts.

A recently established cell line, designated CC3/CUHK3, derived from a squamous cell carcinoma of the uterine cervix of a Hong Kong Chinese patient was investigated for its association with human papillomavirus (HPV) by Southern blot hybridization studies. A "grafted tumour" or xenograft of CC3/CUHK3 has also been successfully established in athymic mice, which showed similar histology to that of the original biopsy. The epithelial nature of the xenografts, like the original biopsy. The epithelial nature of the xenografts, like the original tumour specimen, was also confirmed by transmission electron microscopy which demonstrated the presence of desmosomes and tonofilaments. Moreover transmission electron microscopic examination revealed no HPV particle in either the tumour biopsy or the xenograft tissues. Analysis of the DNA samples extracted from the cervical cancer cell line and the xenograft tissues derived from it showed the presence of HPV type 16 DNA. No DNA sequence related to HPV type 6, 11, or 18 was demonstrated. The viral DNA was found to be integrated into the cellular genome at multiple sites as single copy or head-to-tail tandem repeats. Deletion or rearrangement of the HPV DNA had probably occurred on or subsequent to integration. Viral sequence deletion has also been observed in the grafted tumours derived from CC3/CUHK3.

Characteristics of a cell line established from a Chinese patient with a squamous carcinoma of the uterine cervix.

A new cell line, CC3/CUHK3, was established from a squamous carcinoma of the uterine cervix from a Chinese patient. Light microscopy of the cell line revealed keratin and electron microscopy demonstrated tonofilaments and desmosomes, thereby confirming its epithelial nature. The population doubling time of CC3/CUHK3, estimated from the exponential growth phase of the growth curve established from the cell line was 42 hours. When the tumour cells were inoculated into athymic mouse, a tumour, microscopically diagnosed as a well-differentiated carcinoma, developed. These cells are highly invasive in vitro.