Cytomegalovirus hepatitis in late pregnancy.
A case of pregnancy complicated by cytomegalovirus hepatitis is represented. The mother had a fulminant disease, but she delivered spontaneously at 31 weeks of gestation. The baby was unaffected.
Adult↗
Biomedical subjects
S Saarikoski
Publications and source records attributed to S Saarikoski.
Natural history of cervical human papillomavirus lesions does not substantiate the biologic relevance of the Bethesda System.
The newly introduced Bethesda System proposes to replace the terms dysplasia, carcinoma in situ (CIS), or cervical intraepithelial neoplasia (CIN) with two terms, low-grade squamous intraepithelial lesion (SIL) or high-grade SIL. We tested the biologic relevance of the Bethesda System (ie, its ability to establish a close correlation between biologic behavior and the different grades of lesions) in a series of 528 women with genital human papillomavirus (HPV)-associated precancerous lesions prospectively followed for 10 years. The cervical biopsies were reclassified as either low-grade or high-grade SIL, and the data obtained by colposcopy, Papanicolaou smear, and HPV typing, as well as the biological behavior of the lesions, were analyzed in these two groups. Altogether, 77.4% (376 of 486) of the lesions were classified as low-grade SIL lesions; the rest (22.6%) belonged to the high-grade SIL category. In the low-grade SIL category, 46.8% of the women were 24 years old or younger, as compared with 37.3% in the high-grade SIL group. The colposcopic appearance was normal significantly more frequently in the low-grade SIL lesions (22.1%) than in the high-grade category (8.5%) (P less than .001). A single Papanicolaou smear was inadequate to distinguish between low-grade and high-grade SIL, as evidenced by almost identical distributions of Papanicolaou smear class I and II cells in both categories. Noteworthy was the discovery of normal Papanicolaou smears in 8.2% of the high-grade SIL lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Conization for CIN associated with human papillomavirus infection.
We report results of follow-up by PAP smears and colposcopy in 116 women treated since 1981 by conization for cervical intraepithelial neoplasia with human papillomavirus infection (HPV-CIN). The mean follow-up time was 31.9 (SD 19) months. Preoperative diagnosis was HPV-CIN II (with extension into the endocervix) in 11 cases and HPV-CIN III in 103 cases; two diagnostic conizations were performed. The histological examination of the cone biopsies showed complete excision of CIN in 109 cases (94%). Three patients underwent hysterectomy after conization; one had microinvasion in the cone biopsy, one had suspicion of microinvasion and one had non-radical conization. Three patients (2.6%) were lost to follow-up. After excluding these six patients the primary cure rate of HPV lesions (normal cytological and colposcopical finding after conization) was 82.7%. Four patients (4.6%) had residual CIN after conization. During the follow-up 15 patients had recurrence of HPV infection, only one had HPV-CIN I. HPV 16 was the most common HPV type (56/116, 48.2%) in the conization group and also in the recurrent cases (9/15, 60%). The results support the role of HPV 16 in cervical carcinogenesis.
Adult↗
Osteoporosis risk factors in perimenopausal women.
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Female↗
Systemic alpha-interferon (Wellferon) treatment of genital human papillomavirus (HPV) type 6, 11, 16, and 18 infections: double-blind, placebo-controlled trial.
The efficacy of systemic interferon-alpha (IFN-alpha n1; Wellferon) treatment on genital human papillomavirus (HPV) infections was studied in a double-blind, placebo-controlled trial. A total of 120 women were randomly allocated to receive either interferon (IFN, n = 60) or placebo (n = 60). In both treatment groups, 15 patients with lesions induced by each of the four HPV types (HPV 6, 11, 16, and 18) were included. The dose of IFN was 1.5 x 10(6) IU subcutaneously three times for the first week followed by 3 x 10(6) IU three times weekly for a further 6 weeks. The control patients received matching placebo injections. Ten patients (three IFN-treated and seven placebo-treated) were lost to follow-up. As determined by colposcopy, cytological and histological examinations, and HPV typing (in situ hybridization, ISH), 8 IFN-treated patients (14%) and 11 placebo-treated patients (18%) showed complete response (CR) at the 8th week. The corresponding figures were 22 (37%) and 25 (43%) at the 24th week and 28 (49%) and 25 (49%) at the 52nd week, respectively. The total number of HPV DNA negative patients at Week 8 was 29 (49%) in the IFN group and 24 (40%) in the placebo group (statistically nonsignificant). At Week 24, 37 (63%) of the IFN-treated patients and 39 (67%) of the placebo-treated patients were HPV DNA negative. In 2 placebo-treated cases, cervical lesions progressed to CIN III and were treated by conization after the 24th week. There were 4 recurrences (7%) in the IFN group and no recurrences in the placebo group at the 24th week, corresponding figures at the 52nd week being 6 (11%) and 4 (7%), respectively. When the clinical efficacy was evaluated in relation to the histological grade of lesion and four different HPV types, there were no differences in CR or in the number of HPV DNA negative patients between the two study groups. In conclusion, systemic IFN-alpha therapy did not show any significant therapeutic effect on genital HPV infections (by HPV types 6, 11, 16, and 18) compared to placebo.
Adult↗
Effects of oestradiol valerate plus two different progestogens on serum lipids during post-menopausal replacement therapy.
A total of 27 post-menopausal women were treated with hormone replacement therapy over a period of 6 months for climacteric symptoms. Serum total cholesterol, high-density-lipoprotein (HDL) cholesterol, low-density-lipoprotein (LDL) cholesterol and triglyceride concentrations were determined before therapy commenced and during the third and sixth treatment cycles. One group (13 women) was treated with 2 mg oestradiol valerate plus 7.5 mg megestrol acetate (EV + MA). The other group (14 women) received 2 mg EV plus 0.25 mg norgestrel (Cyclabil). The serum total cholesterol concentration decreased in both groups, the fall being more marked in that treated with Cyclabil. The serum LDL-cholesterol and triglyceride concentrations also decreased in both groups. The serum HDL-cholesterol concentration fell in the Cyclabil group but did not alter in the women treated with EV + MA. Our results suggest that the cyclic addition of megestrol acetate, a 17-alpha-hydroxyprogesterone derivative, to oestrogen therapy does not affect the serum HDL-cholesterol concentration, whereas norgestrel, which is a 19-nortestosterone derivative, causes it to decrease.
Cholesterol↗
Genital human papillomavirus lesions of the male sexual partners: the diagnostic accuracy of peniscopy.
OBJECTIVES: To evaluate the accuracy of peniscopy for identifying human papillomavirus (HPV) lesions in male sexual partners of women with HPV infection. The predictive value of the medical history for HPV infection was also evaluated. DESIGN: Examination of voluntary male partners of the women with HPV infection using colposcopy (peniscopy after acetic acid), cytology and surgical biopsy, the latter being analysed by light microscopy, in situ hybridisation (ISH) and polymerase chain reaction (PCR) for HPV DNA. A detailed medical history was to be taken, too. SETTING: Department of Gynaecology and Obstetrics, Kuopio University Central Hospital, Finland. SUBJECTS: A series of 101 voluntary male partners of 101 women invited for examination, treatment and follow-up for their genital HPV infections on the basis of abnormal Papanicolaou (PAP) smears. RESULTS: On peniscopy 64 (63.4%) of the men presented with lesions either typical of (34.7%) or suspicious for (28.7%) HPV infection. Of the latter, 89% were flat lesions mostly undetectable by the naked eye. The cytologic smear was positive in only nine men. On light microscope, 85.7% of the peniscopically typical lesions were found to be consistent with (68.6%) or suspicious for (17.1%) HPV infection. HPV DNA was found in 33 (34.5%) of the 96 typed biopsies, and never in biopsies from peniscopically healthy areas. In logistic regression analysis of the historical data recorded, only the contact time with the current sexual partner was of predictive value for histologically proven HPV infection. CONCLUSIONS: Peniscopy is an applicable means for the identification of penile lesions due to HPV infection, but it is not a conclusive diagnostic tool capable of differentiating HPV from non-HPV findings.
Adult↗
[Sequential administration of norethisterone and natural oral progesterone during premenopausal menstrual cycle disorders].
A sequential treatment either with norethisterone or with oral natural micronized progesterone was administered, after randomization, to 80 women consulting for premenopausal disorders of the menstrual cycle. In all cases, the initial aspect of the endometrium showed a progesterone deficit with hyperplasia in 50 per cent of cases. At the third and sixth month of treatment, none of the biopsies presented hyperplastic characteristics whether after norethisterone or oral progesterone. However, three months after suspension of treatment, the proliferative or hyperplastic characteristics reappeared in 24 per cent of cases in the norethisterone group, and in 10 per cent of cases in the oral progesterone group. The administration of norethisterone induced a decrease in plasma levels of estradiol (E2), FSH and LH, and sex-hormone-binding globulin (SHBG) (p less than 0.001). No modification was observed during treatment with oral progesterone. The plasma levels of HDL-cholesterol and triglycerides were decreased by norethisterone (p less than 0.001-0.02). A slight decrease in phospholipids was also observed in this group. Treatment with oral natural micronized progesterone therefore offers an attractive alternative for the treatment of premenopausal menstrual disorders.
Administration, Oral↗
Prospective follow-up of genital HPV infections: survival analysis of the HPV typing data.
A series of 532 women with genital HPV infections has been prospectively followed-up without treatment since 1981 for a mean of 50 (+/-21) months. The patients were examined at six month intervals by colposcopy, PAP smears and/or biopsy. HPV typing of all biopsies was completed using in situ, Southern blot and/or sandwich hybridization with DNA probes for types 6, 11, 16, 18, 31 and 33. Survival data analysis was applied to analyse the clinical course (i.e. spontaneous regression and progression) of the HPV lesions stratified by their HPV type, currently available for 458 women. Clinical progression was significantly related to the HPV type present in the lesions. The progression rate was 11.1% (6/54) for HPV 6 lesions, 14.3% (8/56) for HPV 11, 35.2% (32/91) for HPV 16, 12.5% (4/32) for HPV 18, 18.8% (6/32) for HPV 31, 19.4% (6/31) for HPV 33 and 28.6% (4/14) for doubly infected lesions. The lowest progression rate, 6.1% (9/148), was found in lesions which remained constantly HPV DNA-negative. In the survival analysis the probability of progression varied significantly between the six HPV types (p = 0.0005, overall). After grouping the viral types as HPV 6/11 ('low risk'), HPV 16/18 ('high risk') and HPV 31/33 ('intermediate risk') the overall probability of progression remained significantly different (p = 0.0035, overall). In clinical regression, however, the HPV type was not an equally good predictor (p = 0.1952, overall). Within groups HPV 6/11, 16/18 and 31/33 the differences were even less significant (p = 0.4759, overall). In the pairwise comparison significant differences in progression occurred when HPV type 16 was compared to HPV 6, HPV 11 or HPV DNA-negative lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
Biopsy↗
Sequential use of norethisterone and natural progesterone in pre-menopausal bleeding disorders.
Sequential treatment with norethisterone (NET) or natural micronized progesterone (NMP) was administered randomly to 80 consecutive patients attending our clinic because of cycle disorders. The endometrial morphology indicated a need for progestogen therapy in all cases and the endometrium was hyperplastic in half of the women before therapy. Hyperplastic changes disappeared during the first three cycles of treatment with both NET and NMP, the duration of treatment being 6 months. However, the carry-over effect of both progestogens was short: three months after treatment was discontinued a proliferative or hyperplastic endometrial pattern recurred in 24% and 10% of cases, respectively. Whereas NET decreased oestradiol, follicle-stimulating hormone, luteinizing hormone and sex-hormone-binding globulin levels (P less than 0.001) no changes were seen during NMP treatment. High-density-lipoprotein cholesterol and triglyceride levels were also lowered by NET (P less than 0.001-0.02) and there was a slight decrease in phospholipids. NMP treatment induced no changes in serum lipid values and thus offers an alternative form of therapy in premenopausal bleeding disorders.
Adult↗
Lymphocyte beta-2-adrenoceptors and plasma catecholamines in fetal hypoxia.
Conclusive evidence has been furnished that the beta 2-adrenoceptor density in circulating lymphocytes is related to that of beta 2-adrenoceptors in tissues from the same subjects. This study was designed to evaluate the effect of fetal hypoxia on lymphocyte beta 2-adrenoceptor density. The material consisted of 8 hypoxic newborns, 4 delivered by vacuum extraction and 4 by Caesarean section, after approximately 10 h parturition. The control group consisted of 8 vaginally delivered newborns without hypoxia. Umbilical plasma adrenaline and noradrenaline were significantly elevated in the hypoxic newborns. Their lymphocyte beta 2-adrenoceptor density was lower (p less than 0.01) than that in the controls. A plausible explanation for this finding might be downregulation of beta 2-adrenoceptors because of elevated plasma catecholamine level.
Down-Regulation↗
Prevalence of genital human papillomavirus infections in a mass-screened Finnish female population aged 20-65 years.
The results of the nationwide, population-based cervical cancer screening programme (organized by the Finnish Cancer Society since early 1960s) were analysed to establish the prevalence figures (and their changes) for genital human papillomavirus (HPV) infections in an unselected Finnish female population (aged between 20 and 65 years) screened in Kuopio Province between 1981 and 1989. During the study period 82,393 women were invited on a regular basis for the mass-screening, and also 4131 women in a risk group. Of these, a total of 63,115 and 3249 women attended, resulting in the attendance rates of 76.6% and 78.6%, respectively. As a result of the screening, a total of 509 (0.80%) of the 63,115 smears were diagnosed as having the cytological changes consistent with HPV infection in the mass screening. The corresponding figures in the risk group screening were 58/3249 (1.78%). There was a sharply increasing trend in the prevalence of genital HPV infections from 1981 through 1987, from 0.04% to 1.76% (ie a 44-fold increase in 7 years) which, surprisingly, then declined to 1.43% in 1988 and 1.04% in 1989. Based on a random sample of 2084 routine (non-mass-screening) Pap smears (out of (28,861) collected from the files of our laboratory, the prevalence of HPV infections was stratified by age groups. The highest prevalence (6.1%) was observed in women aged between 20 and 29 years, followed by 2.2% in those aged 30-39 years. Using the figures of the relative risk (RR) of HPV infections by age, an estimation was made to assess the prevalence of clinical HPV infections in the Finnish female population in general.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Antenatally diagnosed fetal hydronephrosis. Five year's follow up.
Over a one year period 13 fetuses with urinary tract abnormalities were detected by antenatal ultrasound. Extra-renal dilatation was found in six, in two abnormalities requiring an intervention after delivery. Intra-renal hydronephrosis was present in five cases, of which three required surgery during the neonatal period to relieve the obstruction. Other abnormalities detected were one case with unilateral multicystic kidney and one case with small dysplastic kidneys. Multicystic kidney was removed and the infant with dysplastic kidneys died soon after delivery. Our limited numbers of antenatally detected hydronephrosis will point to the early diagnosis and intervention to avoid renal damage.
Female↗
Decreased numbers of lymphocyte beta 2-adrenoceptors in pregnant women receiving beta 2-adrenergic agonist therapy.
Intravenous infusion of buphenine hydrochloride was administered on 4 successive days to 8 pregnant women with imminent preterm labor. Serial blood samples taken before and throughout the study were assayed for lymphocyte beta 2-adrenoceptor density and cyclic adenosine-3',5'-monophosphate (cAMP). The lymphocyte beta 2-adrenoceptor density declined significantly (p less than 0.01) during the treatment. The plasma cAMP concentration was highest 4 h after commencement of infusion and decreased thereafter. Despite the decrease in lymphocyte beta 2-adrenoceptor density, the clinical response remained good and the parturients did not go into labor until several days after infusion was started.
Adrenergic beta-Agonists↗
[Screening for Down syndrome in the fetus using maternal blood samples].
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Adult↗
Prospective follow-up of cervical HPV infections: life table analysis of histopathological, cytological and colposcopic data.
A total of 532 women with established cervical HPV infection have been prospectively followed (without treatment) since 1981 for a mean of 45 (SD 21) months. The patients were examined by colposcopy, PAP smears and/or punch biopsy every 6 months. The life-table method was applied to analyze the clinical course (i.e. regression and progression) of the HPV lesions, stratified by their colposcopic pattern, PAP smear findings and grade of CIN. During the follow-up, 107 (41.8%) of 256 patients with HPV-NCIN lesion in the first punch biopsy, experienced spontaneous regression. The corresponding proportions for HPV-CIN I, HPV-CIN II and HPV-CIN III lesions were 31.1%, 34.2%, and 20.7%, respectively. In the overall comparison between these four groups, the heterogeneity in the probability of regression was statistically significant (p = 0.0005). Clinical progression was also associated significantly with the histological grade of the lesions in the first biopsy. Progression rate was only 5.8% for HPV-NCIN lesions, as compared to 12.3% for HPV-CIN I, 20% for HPV-CIN II, and 55.2% for HPV-CIN III. The probability of progression varied significantly between the four groups (p less than 0.00001). Cumulative proportion of regression was 46% for patients with PAP smear class I, 84% with class II, and 82% for those with class III, cells, i.e. PAP smear was not of value in predicting the regression. However, PAP smears predicted clinical progression (p = 0.006 overall).(ABSTRACT TRUNCATED AT 250 WORDS)
Actuarial Analysis↗
Risk factors for fever, endometritis and wound infection after abdominal delivery.
Risk factors for postoperative fever, endometritis and wound infection were analyzed in 761 consecutive cesarean sections. Postoperative fever was observed in 12%, endometritis in 4.7% and wound infection in 3% of cases. The relative risk for postoperative fever was increased in cases with postoperative hematoma (relative risk = 16.0), in cases with blood loss over 500 g (relative risk = 1.8) and if the duration of labor exceeded 6 h (relative risk = 1.9). The only significant risk factors for endometritis were amnionitis (relative risk = 8.7), postoperative hematoma (relative risk = 5.0) and age under 24 years (relative risk = 3.0). Wound infections were less frequent in cases with previous cesarean sections (relative risk = 0.15) and after elective cesarean sections (relative risk = 0.22), but duration of operation over 1 h (relative risk = 2.8), induction of labor (relative risk = 3.2) and puerperal endometritis (relative risk = 7.9) increased the risk of wound infection. By elimination of amnionitis and postoperative hematomas the rate of endometritis would have diminished only from 4.7% to 3.8%, a percentage equally unacceptable; diagnostics and prevention should be directed to young patients undergoing caesarean section. Besides technical procedures prevention of endometritis is important for the prevention of wound infection. In hospitals with low postcesarean infectious morbidity antibiotic prophylaxis seems to be unwarranted.
Cesarean Section↗
Lactoferrin in human amniotic fluid.
The concentration of human lactoferrin (LF) was measured by radioimmunoassay or non-competitive avidin--biotin assay in amniotic fluid, cord blood and in the decidua, trophoblast, fetal membranes and umbilical cord. Amniotic fluid was obtained by amniocentesis, and cord blood and tissue samples were taken after delivery or elective Caesarean section. No detectable concentration of LF was found in amniotic fluid before week 20 of pregnancy. A significant increase in the LF concentration was observed around week 30 and it remained high until term. In cord blood, an undetectable or low concentration of LF was measured. In tissue specimens the amount of LF was highest in the decidua (9-95 micrograms/g), a moderate concentration was assayed in the amniotic (2-37 micrograms/) and chorion (2-26 micrograms/g) membrane and in the trophoblast (5-35 micrograms/g). In the umbilical cord, the concentration was less than 1 microgram/g. These results suggest a decidual origin of LF. The role of LF during pregnancy is discussed.
Amnion↗