The 10-year trajectory of aggressive behaviours in autistic individuals.

BACKGROUND: Aggressive behaviours are common in people with neurodevelopmental conditions, contributing to poorer quality of life and placement breakdown. However, there is limited empirical research documenting the prevalence and persistence of aggressive behaviours in autism. In this longitudinal study, aggressive behaviours were investigated in a sample of autistic individuals over 10 years. METHODS: Caregivers of autistic individuals, both with and without intellectual disability, completed questionnaires relating to the presence of aggressive behaviours at T1 [N = 229, mean age in years 11.8, standard deviation (SD) 5.9], T2 (T1 + 3 years, N = 81, mean age in years 15.1, SD 5.9) and T3 (T1 + 10 years, N = 54, mean age in years 24.5, SD 8.1). Analyses examined the presence and persistence of aggressive behaviours and the predictive value of established correlates of aggression. RESULTS: Aggressive behaviours were common at baseline (61.6%) but only persistent in 30% of the sample over 10 years. Higher composite scores of overactivity and impulsivity at T1 were significantly associated with the persistence of aggressive behaviours at T2 (P = 0.027) and T3 (P = 0.012) with medium effect size. CONCLUSIONS: Aggressive behaviours are common in autism, but reduce with age. Behavioural correlates of attention deficit hyperactivity disorder (ADHD) predict the presence and persistence of aggressive behaviour and as such may be useful clinical indicators to direct proactive intervention resources to ameliorate aggressive behaviours.

Anxiolytic-like effects of yohimbine in the murine plus-maze: strain independence and evidence against alpha 2-adrenoceptor mediation.

The influence of alpha 2-adrenoceptor antagonists in animal models of anxiety is quite inconsistent, with results spanning the full range of effect from anxiogenesis to anxiolysis. In the present study, an ethological technique was used to examine the effects of yohimbine (0.5-4.0 mg/kg) on plus-maze behaviour in DBA/2 mice. Results indicated significant anxiolytic-like effects on standard spatiotemporal measures at 2.0-4.0 mg/kg, and on risk assessment measures across the entire dose range. Full-scale follow-up studies with T1 and BALB/c strains confirmed that this action of yohimbine in the murine plus-maze is not peculiar to DBA/2 mice. The more selective alpha 2-adrenoceptor antagonist, idazoxan (0.63-5.0 mg/kg), exerted much weaker behavioural effects in the maze while the alpha 2-adrenoceptor agonist, clonidine (0.01-0.1 mg/kg), produced a profile consistent with non-specific behavioural disruption. Data are discussed in relation to the possible involvement of 5-HT1A receptor mechanisms in the observed anxiolytic-like effects of yohimbine in the murine plus-maze.

Noncondylomatous cervical wart virus infection.

Human papillomavirus (HPV) infections of the genital tract frequently involve cervical epithelium and produce a macroscopically flat lesion that the authors have called noncondylomatous cervical wart virus infection (NCWVI). Over a 6-month period, 92 of 7281 routine cervical smears (1.3%) and 46 of 183 colposcopically directed punch biopsies (25%) showed morphologic evidence of wart virus infection. The etiologic role of HPV was confirmed by the demonstration of virus particles in 24 of 53 cases (45%) examined by electron microscopy. The colposcopic features of NCWVI consist principally of epithelial opacity and vascular atypia, leading to frequent confusion with cervical intraepithelial neoplasia. Differences in surface contour, color, vascular patterns, and topography generally permit colposcopic differentiation. These 2 conditions sometimes coexist; whether the association is causal or casual in not presently known.

The value of Medicare statistics in monitoring Pap smear screening. Screening versus non-screening smears: the role of the laboratory.

In November 1991 separate Medicare item numbers were introduced to distinguish screening from non-screening cervical smears for the purposes of monitoring the screening programme. Referring doctors are now expected to indicate the appropriate item number on the request form accompanying the Pap smear. To test compliance with this requirement, we examined 1000 consecutive request forms for cervical smears received in August 1993. We found that 22.7% had no item number indicated and that for a further 10.4% the item number given appeared to be incorrect. As the account issued by the laboratory must show an item number the ultimate responsibility for the choice of the item number rests with the laboratory. Using the guidelines supplied by Medicare, we formulated detailed criteria to classify smears as screening or non-screening, based on the patient's past smear history and/or clinical information provided by the referring doctor. Applying these criteria to cervical smears received in this laboratory in 1993 resulted in 70% being classified as screening and 30% as non-screening smears. Analysis of the cytological predictions for these smears showed substantially higher rates for all grades of abnormalities in the non-screening smears, thus lending support to the validity of our classification system. We conclude that classifying smears into screening and non-screening categories provides valuable information for statistical and quality assurance purposes but can only be useful for monitoring purposes if the criteria for assigning smears are applied consistently by all doctors and laboratories.

Malignant melanoma metastases in the placenta: a case report.

Although the coincidence of pregnancy and maternal malignancy is not rare, only 29 cases of metastases to the products of conception have been previously reported and of these, 14 have been of malignant melanoma. The present case of widespread maternal malignant melanoma metastasizing to the placenta further emphasizes this trend. The mother died of malanomatosis two weeks after induced labour at 36 weeks gestation. The infant, despite widespread placental involvement including apparent foetal vascular invasion, is well and without clinical evidence of disease five months after delivery.

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.

Extrauterine mesodermal (müllerian) adenosarcoma. A case report.

Extrauterine mesodermal (müllerian) adenosarcomas have only recently been described, and this is the first reported case from Australia. These tumours fall within the category of common epithelial tumours' in the World Health Organisation (W.H.O.) classification of ovarian tumours and comprise benign looking epithelial structures (glands, papillae) in association with sarcomatous stroma. They are thus distinct from malignant mesodermal mixed tumours in which both epithelial and stromal elements are cytologically malignant.

Noncondylomatous wart virus infection of the postmenopausal cervix.

Noncondylomatous papilloma virus infection of the cervix is much more common than formerly realized. The majority of patients are young, but two cases are reported here in postmenopausal women.

Electron microscopic detection of papilloma virus particles in selected koilocytotic cells in a routine cervical smear.

A routine cervical smear from a 56-year-old postmenopausal woman showed appearances indicative of papilloma virus infection with atypia. In an attempt to prove the diagnosis, the smear was reprocessed for electron microscopic examination. The reprocessing technique is described. Ultrastructural preservation was poor, and significant shrinkage was observed. In spite of these technical difficulties it was possible to prove that the selected cells in the smear contained papilloma virus particles. The virus particles seen were intranuclear in location and spherical in shape with a diameter of 40 to 50 nm. As was demonstrated in this case, the technique described will prove useful in evaluating the reliability of various diagnostic criteria for identifying viral infections in routine smears. This will apply particularly in cases where cultural confirmation of a reported viral infection is not possible.

Adenovirus infection of the cervix.

A case is recorded in which intranuclear inclusions suggesting adenovirus infection were recognized in a routine Papanicolaou smear. The patient was recalled for virologic studies and adenovirus type 19 was cultured from the cervix. The patient had a recent history of systemic illness with conjunctivitis, and a friend had conjunctivitis at the same time which was also proven to be due to adenovirus of the same serotype. This is the first reported instance in which adenovirus infection of the cervix suspected on cytologic findings has been confirmed by virus culture.

The significance of noncondylomatous wart virus infection of the cervical transformation zone. A review with discussion of two illustrative cases.

The clinicopathologic features are described of two patients whose cervical cytology smears showed features which were thought initially to indicate dysplasia, but which were later considered to be those of condylomata acuminata. One patient was an immunosuppressed renal transplant recipient, the other was a routine gynecologic clinic patient. No condylomas were recognizable clinically, and colposcopy showed only a flat but atypical transformation zone. Biopsy in each case showed a noncondylomatous warty lesion and wart virus particles were demonstrated by electron microscopy. These cases highlight the clinical, colposcopic, cytologic and histologic diagnostic difficulties which are encountered with cervical transformation zone wart virus infections, which are commoner than formerly realized. The possible relationship of wart virus infection to cancer of the cervix is also discussed.

Comparison of ThinPrep and Pap smear in relation to prediction of adenocarcinoma in situ.

OBJECTIVE: To compare the accuracy of reporting split-sample ThinPrep (SSTP) and the Pap smear (PS) in cases of histologically confirmed adenocarcinoma in situ (AIS) and to ascertain the reasons for any discrepancies. STUDY DESIGN: Comparison of prospective PS and ThinPrep (TP) predictions with unblinded review of TP slides. RESULTS: In 30 paired cytologic samples, AIS was originally accurately predicted by PS in 20 (67%) and SSTP in 14 (47%). In the 16 cases in which SSTP failed to predict AIS, on review 4 were regarded as cytologic undercalls, and in the remaining 12 no diagnostic material was found on the first TP slide. In eight of these, further TP slides were made; in three, diagnostic material was present on subsequent TP slides, and in five it was not. Differences in cytologic appearances of AIS were noted between TP and PS. CONCLUSION: Even though in routine practice SSTP did not perform as well as PS in predicting AIS, it has the potential to do so. These results cannot anticipate the performance of direct-to-vial TP with respect to prediction of AIS.

Sampling, sampling errors and specimen preparation.

To obtain an adequate cervical smear for making a correct cytologic diagnosis, smear taking, laboratory handling and interpretation must be optimal. Many people are involved, and only by a combined effort of all links can this target be seriously approached: the smear takers will have to be open minded about technical improvements and read the morphologic descriptions cautiously; in the laboratory, cytotechnicians and physicians will have to challenge themselves and each other. It is mandatory to discard specimens that do not meet general standards of adequacy. At present a host of new techniques are being implemented. It is not feasible for all laboratories to be engaged in testing these new methods, but we are all requested to follow the development the best we can and switch to new ways when justified. Our working conditions are very different; therefore, it is our professional responsibility and plight to respond at the right time. So far the conclusion is that the conventional Pap smear is the international standard of care for the diagnosis of cervical cancer precursers in cancer screening programs. Certainly, this may change within a very short time. Liquid-based techniques, and in particular HPV technologies, are just around the corner.

Have the most recent Pap smear guidelines affected GP practices?

OBJECTIVE: To assess the attitudes and knowledge of a sample of NSW general practitioners on issues concerning Papanicolaou (Pap) smear tests after the 1991 National Guidelines were established. DESIGN: During January-March 1994, a sample of Sydney general practitioners obtained from a list from the Department of General Practice, Royal North Shore Hospital, were asked to complete a questionnaire based on Pap smear screening. Issues explored included the perceived value of Pap smears, views on recommended screening intervals and the type of patients believed to be at highest risk of developing cervical cancer. SETTING: Northern Sydney metropolitan area. RESULTS: Seventy of 104 general practitioners from the Department of General Practice, Royal North Shore Hospital, returned completed questionnaires. Ninety-five per cent of respondents rated the Pap-smear as an extremely valuable screening test for cervical cancer prevention. The majority of GPs surveyed tended to overscreen younger patients and underscreen both older women and those at highest risk of developing cervical cancer. Seventy-seven per cent of doctors indicated the use of a patient reminder system, in most cases provided by a pathology laboratory but 43% were unaware of the NSW Cancer Council's reminder service. CONCLUSION: Our study suggests that Pap smears are viewed as an important means of cervical cancer prevention. Unfortunately the majority of respondents did not adhere to the recommended guidelines of 2-yearly screening. Possible changes to the current system include improved awareness of the 1991 National Guidelines, greater public awareness of the NSW Cancer Council reminder service, and the establishment of a state cytology registry.