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Human papillomavirus DNA in distant metastases of cervical cancer
Citations from the Literature strong proliferative and invasive character of higher grade endometrial adenocarcinomas. This is the first demonstration of the presence of nuclear type II EBS and their possible pathological role in human endometrial cancer, and of the high prognostic significance of nuclear type I ER to identify a subgroup having a fatal form of the disease in a 5-year survival study. Human pa@IIumavIrus DNA in distant metsstases of cervical cancer
Ikenberg H.; Teufel G.; Schmitt B.; Kommoss F.; Stanimirovic B.; PIleiderer A. DEU GYNECOL ONCOL 1993 48/l (56-60) Eighteen distant metastases from cervical cancer to the extrapelvic abdomen, extraabdominal lymph nodes, vulva, suburethral region, skin, and breast in 17 patients were analyzed by Southern blot hybridization under nonstringent and stringent conditions for the prevalence of human papillomavirus (HPV) type 11, 16, 18, 31, 33, and 35 DNA. Fourteen metastases in thirteen patients were HPV-positive. Thirteen tumors contained HPV-16 and one HPV-related sequences with varying copy number. In 9 of 11 cases, where the corresponding primary tumor could be studied, HPV positivity and type were identical. Two HPV-negative primary lesions had HPV-positive metastases; in three cases differences in restriction pattern or copy number were revealed. The HPV status showed no clear association with age of the patient, latency period between primary tumor and metastasis, histological Endings, therapy, and clinical course of the disease after metastasis. The rather conserved presence of HPV DNA in distant metastases of cervical carcinoma underlines the importance of these viruses also for the maintenance of the malignant state. The ‘less tbnn optimal’ cytology: Importance in obstetric patients and in a routine gynecologic population
Kost E.R.; Snyder R.R.; Schwartz L.E.; Hankins G.D.V. USA OBSTET GYNECOL 1993 81/l (127-130) Objective: To determine whether patients with less than optimal Papanicolaou tests constitute a low-risk group for developing subsequent abnormalities and thus do not need early repeat screening. Methods: For the IO-month period October 1989 to August 1990, all screening Papanicolaou tests were classified by the 1988 Bethesda System. Tests designated as less than optimal solely on the basis of lack of an endocervical component were the subject of the study. Prenatal patients with less than optimal tests had repeat tests at the postpartum visit (delayedrepeat group), whereas gynecologic less than optimal tests were repeated within 4 weeks (early-repeat group). The frequency of cytologic abnormalities in our routine gynecologic population was compared with that for both the delayed- and early-repeat testing groups. Results: The less than optimal rate in obstetric patients was 10.2% (153 of 1492), which was significantly higher than the 5.6% rate (473 of 8411) in the routine gynecologic population (P < 0.0001). The rates of dysplasia or combined abnormalities (dysplasia, human papillomavirus, or
99
atypia) in the delayed-repeat group did not differ signiftcantly from those in the routine gynecologic population (P = 0.69 and P = 0.33, respectively). However, the rates of dysplasia or combined abnormalities were significantly lower in the early-repeat group than in the routine gynecologic population (P = 0.02 and P = 0.003, respectively). Conclusions: Less than optimal cervical cytologies occurred almost twice as often in obstetric as in gynecologic patients. Prenatal less than optimal test results were not associated with important cervical pathology, and repeat testing may safely be deferred until postpartum. In addition, early repeat testing in gynecologic patients is a low-yield procedure.
PSYDIOSMOATIC
PROBLEMS
The loss of a baby at birth: The role of the Bereavement Officer
Appleton R.; Gibson B.; Hey E. GBR BR J OBSTET GYNAECOL 1993 100/l (51-54) Objective: To illustrate and emphasize the role of the Bereavement Officer in the management of perinatal death, as recommended and envisaged by a report of the Royal College of Obstetricians and Gynaecologists in 1985. Design: A description of the training and responsibilities of the officer and an account of her involvement with all perinatal deaths within a given period. Setting: Perinatal deaths in the 12 months, 1October 1989 to 30 September 1990 from a regional neonatal intensive care unit within a maternity hospital. Subjects: A total of 59 registerable deaths, three late terminations (severe fetal abnormality) and 12 late mid-trimester miscarriages were dealt with by the Bereavement Officer in this 12 month period. Results: The introduction of this service to our unit has led to an improvement in our management of both perinatal and fetal deaths. Conclusion: The service has justified fully the recommendations made by the Royal College of Obstetricians and Gynaecologists. Reducing parents’ distress will facilitate their grieving and any subsequent bereavement counselling. PsychosexuaI dysfunction in women with gynecoIogical cancer following radical pelvic surgery
Comey R.H.; Crowther M.E.; Everett H.; Howells A.; Shepherd J.H. GBR BR J OBSTET GYNAECOL 1993 100/l (73-78) Objective: To assess the prevalence and severity of psychosexual dysfunction in women treated for cancer of the cervix and vulva by radical vulvectomy, Wertheim’s hysterectomy and pelvic exenteration; and to identify the risk factors for sexual morbidity and ways in which it might be reduced. Design: Retrospective study of patients by questionnaire and semistructured interview, 6 months to 5 years following surgery. Setting: Gynaecology-Oncology Unit of a general hospital. Patients: 105 English speaking women with gynecological cancer. Results: 98% of the women in relationships had been sexually active prior to surgery. Of this group, 24% had no sexual difficulties post-operatively; 66% of the latter still had problems more than 6 months later, and 15% of the latter never resumed intercourse (excluding those with a colpectomy). 82% Inr J Gynecol Obstet 43
Ikenberg H.; Teufel G.; Schmitt B.; Kommoss F.; Stanimirovic B.; PIleiderer A. DEU GYNECOL ONCOL 1993 48/l (56-60) Eighteen distant metastases from cervical cancer to the extrapelvic abdomen, extraabdominal lymph nodes, vulva, suburethral region, skin, and breast in 17 patients were analyzed by Southern blot hybridization under nonstringent and stringent conditions for the prevalence of human papillomavirus (HPV) type 11, 16, 18, 31, 33, and 35 DNA. Fourteen metastases in thirteen patients were HPV-positive. Thirteen tumors contained HPV-16 and one HPV-related sequences with varying copy number. In 9 of 11 cases, where the corresponding primary tumor could be studied, HPV positivity and type were identical. Two HPV-negative primary lesions had HPV-positive metastases; in three cases differences in restriction pattern or copy number were revealed. The HPV status showed no clear association with age of the patient, latency period between primary tumor and metastasis, histological Endings, therapy, and clinical course of the disease after metastasis. The rather conserved presence of HPV DNA in distant metastases of cervical carcinoma underlines the importance of these viruses also for the maintenance of the malignant state. The ‘less tbnn optimal’ cytology: Importance in obstetric patients and in a routine gynecologic population
Kost E.R.; Snyder R.R.; Schwartz L.E.; Hankins G.D.V. USA OBSTET GYNECOL 1993 81/l (127-130) Objective: To determine whether patients with less than optimal Papanicolaou tests constitute a low-risk group for developing subsequent abnormalities and thus do not need early repeat screening. Methods: For the IO-month period October 1989 to August 1990, all screening Papanicolaou tests were classified by the 1988 Bethesda System. Tests designated as less than optimal solely on the basis of lack of an endocervical component were the subject of the study. Prenatal patients with less than optimal tests had repeat tests at the postpartum visit (delayedrepeat group), whereas gynecologic less than optimal tests were repeated within 4 weeks (early-repeat group). The frequency of cytologic abnormalities in our routine gynecologic population was compared with that for both the delayed- and early-repeat testing groups. Results: The less than optimal rate in obstetric patients was 10.2% (153 of 1492), which was significantly higher than the 5.6% rate (473 of 8411) in the routine gynecologic population (P < 0.0001). The rates of dysplasia or combined abnormalities (dysplasia, human papillomavirus, or
99
atypia) in the delayed-repeat group did not differ signiftcantly from those in the routine gynecologic population (P = 0.69 and P = 0.33, respectively). However, the rates of dysplasia or combined abnormalities were significantly lower in the early-repeat group than in the routine gynecologic population (P = 0.02 and P = 0.003, respectively). Conclusions: Less than optimal cervical cytologies occurred almost twice as often in obstetric as in gynecologic patients. Prenatal less than optimal test results were not associated with important cervical pathology, and repeat testing may safely be deferred until postpartum. In addition, early repeat testing in gynecologic patients is a low-yield procedure.
PSYDIOSMOATIC
PROBLEMS
The loss of a baby at birth: The role of the Bereavement Officer
Appleton R.; Gibson B.; Hey E. GBR BR J OBSTET GYNAECOL 1993 100/l (51-54) Objective: To illustrate and emphasize the role of the Bereavement Officer in the management of perinatal death, as recommended and envisaged by a report of the Royal College of Obstetricians and Gynaecologists in 1985. Design: A description of the training and responsibilities of the officer and an account of her involvement with all perinatal deaths within a given period. Setting: Perinatal deaths in the 12 months, 1October 1989 to 30 September 1990 from a regional neonatal intensive care unit within a maternity hospital. Subjects: A total of 59 registerable deaths, three late terminations (severe fetal abnormality) and 12 late mid-trimester miscarriages were dealt with by the Bereavement Officer in this 12 month period. Results: The introduction of this service to our unit has led to an improvement in our management of both perinatal and fetal deaths. Conclusion: The service has justified fully the recommendations made by the Royal College of Obstetricians and Gynaecologists. Reducing parents’ distress will facilitate their grieving and any subsequent bereavement counselling. PsychosexuaI dysfunction in women with gynecoIogical cancer following radical pelvic surgery
Comey R.H.; Crowther M.E.; Everett H.; Howells A.; Shepherd J.H. GBR BR J OBSTET GYNAECOL 1993 100/l (73-78) Objective: To assess the prevalence and severity of psychosexual dysfunction in women treated for cancer of the cervix and vulva by radical vulvectomy, Wertheim’s hysterectomy and pelvic exenteration; and to identify the risk factors for sexual morbidity and ways in which it might be reduced. Design: Retrospective study of patients by questionnaire and semistructured interview, 6 months to 5 years following surgery. Setting: Gynaecology-Oncology Unit of a general hospital. Patients: 105 English speaking women with gynecological cancer. Results: 98% of the women in relationships had been sexually active prior to surgery. Of this group, 24% had no sexual difficulties post-operatively; 66% of the latter still had problems more than 6 months later, and 15% of the latter never resumed intercourse (excluding those with a colpectomy). 82% Inr J Gynecol Obstet 43