Use of the same archival papanicolanou smears for detection of human papillomavirus by cytology and polymerase chain reaction.

An optimal method for the processing of archival cervical Papanicolaou (pap)-stained smears for the amplification of human papillomavirus (HPV) DNA by polymerase chain reaction (PCR) was developed. This methodology was then applied to a series of 44 pap smears designated as HPV positive or negative (on the basis of both major and minor cytological criteria) or cervical intraepithelial neoplasia (CIN)-cancer. For the detection of HPV DNA, each sample was tested with the consensus GP5/6 primers, and when negative, with CPI-IIG primers. The HPV DNA was detected in 100% (8 of 8) of CIN-cancer smears using the GP5/6 primers. In smears with cytological evidence of HPV without CIN. the use of both sets of primers yielded positive results in 100% (19 of 19) of the samples. Direct sequence analysis of PCR products showed that 16 of the 27 HPV-positive samples contained more recently described HPV types. When tested with both primer combinations, all 17 cytologically negative smears were positive for beta-globin but negative for HPV DNA. The findings show the value of using archival pap smears for further investigations to address issues such as latency, but they indicate that cytological criteria and DNA technology will be critical factors in the reliability of the results.

The fetal adrenal gland: definitive cortex cystic change, lipid patterns, and their relationship to fetal disease and maturity.

A study of 103 fetal adrenals obtained from stillborn fetuses and those dying in the neonatal period was performed to assess the significance of definitive cortex cystic change, compact cell change and lipid patterns, and their relationship to other pathological processes. The findings confirm that these changes are more common in intrauterine infection and antepartum hemorrhage and are to a lesser extent complications of prematurity. They also correlate with gestational age. It is proposed that the changes seen are due to the gland being immature.

The fetal adrenal gland: lipid distribution with associated intrauterine hypoxia.

The adrenal glands of 134 fetuses, either stillborn or dying within 24 h, were studied to ascertain the lipid droplet pattern in the fetal cortex. The findings were correlated with the associated placental pathology and clinical features. Three patterns were identified (types I, II and III), representing increasing amounts of coarse lipid droplets. The type III pattern showed the most lipid accumulation and occurred in cases where the placental pathology or the clinical situation was indicative of fetal hypoxia.

Clear cell adenocarcinoma of the uterine cervix: a histological and histochemical study.

A case of Mullerian clear cell adenocarcinoma of the uterine cervix occurring in a young women is presented. A detailed histological and histochemical study of this type of tumour is important so as to separate it from the clear cell tumour of mesoenphric origin. The association of Mullerian clear cell adenocarcinoma and other abnormalities of the vagina and cervix with the administration of maternal nonsteroidal oestrogens has been recently stressed in the literature. However, our patient is illustrative of the 30-50% of cases reported to date which have few if any of the associated abnormalities of the genital tract and have no known exposure to non-steroidal oestrogens.

Placental candidiasis: report of three cases with a review of the literature.

Three new cases of placental candidiasis are reported. Two were associated with fetal cutaneous candidiasis and one with fetal systemic candidiasis. The systemic case was associated with an intrauterine contraceptive device. Infection of the placenta results in small 'granulomata' under the surface of the cord and a diffuse chorioamnionitis of the membranes and chorionic plate. In reviewing the 24 previously reported cases it can be seen that systemic. Candida infection of the fetus results in prematurity and death, infection can occur across intact membranes, and systemic candidiasis in the fetus is likely to be associated with an intrauterine device.

PIP: Placental candidiasis is a rare condition; only 24 cases are reported in the literature. 3 additional cases are reported, 2 were associated with fetal cutaneous candidiasis and responded to administration of oral nystatin. Maternal vaginal cultures were positive in 1 of the 2 cases. In a 3rd case, systemic candidiasis was present. The child was delivered prematurely and died 90 minutes after delivery of severe respiratory distress. The mother had continuous vaginal candidiasis unresponsive to treatment throughout the pregnancy. In addition, an IUD was present. Other researchers have determined the criteria for Candida amniotic infection as: exclusive presence of Candida albicans in the different lesions, subacute or chronic specific lesions of fetal adnexae, and clinical manifestations in the newborn. The pathology of the placenta includes microscopic granulomata and presence of filaments or spores on the cord and histological change of the membrane or chorionic plate revealing intense chorioamnionitis with occasional focal granuloma. A review of the case reports indicates that 12 of the 27 infants were delivered after the 36th week and all but 1 were normal or recovered rapidly from cutaneous candidiasis. 15 of the 27 were delivered before the 36th week and only 1 survived. 6 were stillborn, and where histology was reported, systemic candidiasis was present. The 7 infants who died shortly after birth had Candida albicans. 1 infant was anencephalic. In only 5 cases did the membrane rupture more than 12 hours prior to delivery suggesting either Candida crosses the intact membrane or the possibility of a small leaking tear in the membrane. In 7 of the cases an IUD was present and the infection tended to be more overwhelming; all infants died from infection and septicemia, not complications of prematurity. The presence of the IUD is suspect for increased infection. The association of IUDs and Candida albicans-induced septicemia and fetal death warrants careful consideration of the advisibility of attempted removal of the IUD when Candida albicans is grown from the vaginal in the antenatal period.

Brenner tumours of the ovary: a study of the histology, immunohistochemistry and cellular DNA content in benign, borderline and malignant ovarian tumours.

Brenner tumours are now generally regarded as being of ovarian epithelial origin. Most have a limited growth potential and are benign. For this reason they are usually found incidentally at hysterectomy. In common with other epithelial ovarian tumours there is a histopathological spectrum of appearances ranging from benign through borderline to invasive malignancy. In this series all 54 tumours were graded according to the degree of cytological atypia, presence of mitoses and tumour necrosis. Heterogeneity of DNA content was observed in the higher grade tumours, two of the four being diploid and two being aneuploid (all benign tumours being diploid). The presence of aneuploidy correlated with the histological features and a poor clinical prognosis. Immunohistochemical staining for keratoprotein was found to be of limited value in the diagnosis of Brenner tumours and their metastases.

Atypical polypoid adenomyoma: a case report with ultrastructural examination.

A case of atypical polypoid adenomyoma occurring in a 40 yr-old female is reported. The lesion was composed of irregular glands lined by atypical epithelium lying in a spindle cell stroma containing smooth muscle cells. The mitotic count of the stroma was less than 1 per 10 high power fields. Squamous metaplasia was present in the glandular elements. Ultrastructural examination of the stroma confirmed the presence of smooth muscle cells. The lesion is compared with similar cases previously reported. The differential diagnosis is considered, including endometrial adenocarcinoma, adenomyosis, endometrial polyps and mixed Mullerian tumours. Atypical polypoid adenomyoma is a benign lesion, and conservative management is recommended.

Squamous cell carcinoma in situ arising in inflammatory cloacogenic polyps: report of two cases with PCR analysis for HPV DNA.

Inflammatory cloacogenic polyp (ICP) is regarded as part of the spectrum of pathological changes encountered in mucosal prolapse syndrome (MPS)/solitary rectal ulcer. We present the clinicopathological features of two females with squamous cell carcinoma in situ arising in their ICPs. Human papillomavirus (HPV) type 16 was demonstrated in the areas of squamous carcinoma in situ in both polyps by polymerase chain reaction. These cases highlight the need for close scrutiny of the squamous components of these lesions.

Filiform viral squamous papillomas on sheep.

Filiform squamous papillomas occur rarely on young sheep and correspond closely to those on cattle and other species; they lack the fibromatous component of papillomas reported previously. This paper describes microscopical, immunological and molecular evidence for the presence of a putative ovine papillomavirus in these lesions.

Serological evidence for the association of papillomavirus and cervical neoplasia.

Serum was collected from patients with anogenital warts, cervical intraepithelial neoplasia (CIN), and invasive squamous carcinoma of the uterine cervix. All sera were screened with a solid-phase enzyme-linked immunosorbent assay for an IgG antibody to a group-specific papillomavirus antigen. All three study groups had higher antibody levels than did control groups of children and adults. The invasive-cancer group had a higher geometric mean titre than the CIN or anogenital wart groups. It is proposed that patients with invasive squamous cancer of the cervix are exposed to human papillomavirus (HPV) antigens and that HPV has a role in the aetiology of cervical squamous-cell carcinoma.

Papillomavirus infection of the female genital tract before and after treatment: a cytological, colposcopic and histological study.

Papillomavirus infection (HPV) of the female genital tract is now recognized as a major risk factor for the development of neoplasia. With the combined investigative modalities of cytology, colposcopy and histopathology, it is clear that precancerous changes and HPV are closely associated. The differentiation of innocent HPV infection from progressive premalignant disease is not clear-cut in all situations. Despite various treatment modalities, close follow-up of these patients by cytology, colposcopy and histology reveals the presence of persistent genital tract infection by HPV.

Moving to micro-based cost accounting.

Cost accounting information is needed for flexible budgeting, productivity management, contracting with third party payors, physician evaluation, and investment and divestment decisions. This article discusses why an increasing number of hospital managers are turning to microcomputer-based accounting systems as solutions to these growing needs.

Cephalothoracopagus syncephalus: a case report with previously unreported anatomical abnormalities and chromosomal analysis.

A case of cephalothoracopagus conjoined twins is presented. The abnormality was detected antenatally by the use of ultrasonography. A detailed anatomical description is given, including previously unreported abnormalities of the cerebrum and genito-urinary tract. Chromosomal analysis was also performed. This showed a pericentric inversion of one chromosome 9 in the fetus. Studies performed on the mother showed pericentric inversion of both chromosome 9s. A comparison of this case with previously reported cases in the literature is then given.

Erysipelothrix endocarditis.

This communication describes the second reported Australian case of erysipelothrix endocarditis; after treatment with penicillin, the patient survived. It also gives up-to-date summary and brief discussion of the literature.

Giant condyloma acuminatum of the vulva and anal canal.

This publication describes the second known reported case of benign giant condyloma acuminatum of the vulva and anal canal (Buschke-Loewenstein tumour). The diagnosis of squamous cell carcinoma was made initially on clinical examination and could not be excluded by punch biopsy. A full pathological study of the tumour established the diagnosis. A defunctioning colostomy and a perineo-ano-vulvectomy with groin gland dissection was performed and the patient is free of disease 36 months later. The biology of this type of tumour is discussed.

Fetal umbilical artery flow velocity waveforms and placental resistance: pathological correlation.

Placental microvascular anatomy was correlated with antenatal assessment of the umbilical circulation in 106 patients to further validate the measurement of the A/B ratio (the ratio of peak systolic to least diastolic flow velocity) of the umbilical artery flow velocity time waveforms as an index of blood flow resistance. Three groups of patients were studied: a normal group of 38 uncomplicated pregnancies, a control group of 33 potentially 'at risk' pregnancies with a normal A/B ratio matched by risk factors and gestation with the third group of 35 pregnancies with a high A/B ratio. Placental arterial resistance was quantitated by counting the number of small muscular arteries (less than 90 micron diameter) in the tertiary stem villi in a standard microscopic field (mean 18.5 fields/placenta). The modal small arterial vessel count was shown to be significantly less in the group with a high fetal risk and a high A/B ratio (1-2 arteries/field) than in both the normal and control groups (7-8 arteries/field). The tertiary villus count did not vary between groups. Antenatal studies of umbilical artery flow velocity waveforms with Doppler ultrasound identify a specific microvascular lesion in the placenta characterized by obliteration of small muscular arteries in the tertiary stem villi.

Recurrent cutaneous erythralgia and arthralgia.

Two cases are reported of Vietnamese men who presented in young adult life with recurrent, painful, erythematous patches (which we have termed "erythralgia") over and adjacent to joints and accompanied by marked constitutional symptoms of malaise and lethargy, arthralgia and in one patient, fever. In the other, from the onset of the disease there were nodules over the bony prominences and in the interphalangeal regions of the fingers. The duration of the disease was over 12 years, the duration of each episode without therapy was one week and the interval between episodes was one to two weeks. In addition the patients showed a raised ESR and peripheral neutrophil leucocytosis of over 70%. There was a rapid response, within hours, to non-steroidal anti-inflammatory agents. Skin biopsies taken at varying stages of the disease episode failed to demonstrate neutrophils thereby failing to satisfy one major criterion of Sweet's Syndrome. Direct immunofluorescence studies were negative. Biopsy of the nodules did not show rheumatoid pathology. The serum rheumatoid factor was negative. Investigations failed to demonstrate any recognised pattern of cutaneous or rheumatologic disease; infections such as borreliosis were excluded. Both patients showed evidence of past hepatitis B infection. As recurrent painful cutaneous erythema is an uncommon phenomenon in dermatology except where the patient is suffering from recurrent cellulitis of the lower limbs, the patients reported here exhibit a pattern of disease not previously described.