Identification of fetal nucleated red blood cells in the maternal circulation during pregnancy using anti-hemoglobin-epsilon antibody.

AIM: To investigate the use of anti-hemoglobin-epsilon antibody in order to identify fetal cells in the maternal circulation during pregnancy. MATERIALS AND METHODS: 48 blood samples were obtained from pregnant women, 26 in the 1st trimester and 22 in the 2nd trimester. Magnetic activated cell sorting was used for fetal cell enrichment followed by immunophenotyping with a monoclonal antibody against hemoglobin-epsilon. FISH with X, Y and 21 chromosome-specific probes was performed in 29 cases. RESULTS: The mean number of epsilon-positive cells was 9.2 (range 2-23) in the 1st trimester, 4.8 (range 3-13) in the 2nd trimester and 22 (range 15-28) in pregnancies with Down syndrome. No significant difference was noted in the number of epsilon-positive nucleated red blood cells (NRBCs) isolated from carriers and noncarriers of beta-thalassemia. FISH analysis was successful in 24 cases. In 4 cases with known male fetuses, an average of 4.7 epsilon-positive cells showed a Y signal. In 4 cases with Down syndrome, all epsilon-positive cells showed 3 signals for chromosome 21. CONCLUSION: Anti-hemoglobin-epsilon antibody has increased specificity for fetal NRBCs and should be preferentially used to improve noninvasive prenatal diagnosis of chromosome abnormalities from fetal cells in maternal blood.

Peoscopic diagnosis of flat condyloma and penile intraepithelial neoplasia. Clinical manifestation.

Peoscopy was performed in order to assess penile lesions in the male sexual partners of 326 women with cervical intraepithelial neoplasia (CIN) or flat condyloma (FC). Each patient was submitted to a careful naked-eye inspection, peoscopy and biopsy of any suspicious lesion which was confirmed histologically and immunohistochemically. A brush cytologic examination of the distal portion of the urethra was also performed. The distribution of penile lesions was as follows: (1) 8 patients with herpes virus infection; (2) 37 patients with condyloma accuminata (CA); (3) 89 patients with FC; (4) 51 patients with FC and CA; (5) 18 patients with penile intraepithelial neoplasia grade 1 (PIN-I); (6) 2 patients with PIN-II; (7) 17 patients with PIN-III; (8) 92 patients with no penile lesions; (9) 7 patients with human papilloma virus infection of papillae coronae glandis, and (10) 5 patients with FC of the distal portion of the urethra. Naked-eye inspection revealed the presence of penile lesions in 39 of 233 patients (16.73%). Peoscopic examination revealed the presence of penile lesions in 233 of 326 patients (71.48%). In 135 of 155 patients the peoscopic findings were in accordance with the histologic diagnosis (87.09%). Immunohistochemical (by indirect peroxidase-antiperoxidase method) detection of virus antigens was positive in 16 of 34 patients (47.03%). It is concluded that peoscopy of the male sexual partners of women with CIN or FC should be performed to better assess the treatment used in the couple.

Treatment of penile intraepithelial neoplasia (PIN) with interferon alpha-2a, CO2 laser (vaporization) and 5-fluorouracil 5% (5-FU).

This study was undertaken to assess the effectiveness of CO2 laser (vaporization), 5-FU topical application and Interferon (IFN alpha-2a) parenterally in the therapy of penile intraepithelial neoplasia (PIN). From March 1986 to September 1991, 1,372 men, sexual partners of women with condylomata accuminata or flat or cervical intraepithelial neoplasia (CIN), were submitted to peoscopy, of 1,019 men who presented with various lesions caused by human papillomavirus (HPV)-confirmed histologically-208 were treated for PIN. The best treatment modalities irrespective of grade of lesion were found to be the combination of 5-FU plus CO2 laser vaporisation plus IFN alpha-2a (high dose) (96.15%), the combination of 5-FU plus CO2 laser vaporization (87.09%) and the combination of CO2 laser vaporization plus IFN alpha-2a (high dose) (80%). It is concluded that IFN alpha-2a (low dose) can be used as first line treatment in combination with 5-FU in patients with PIN II and as an adjuvant treatment (high dose) in patients with recurrent PIN I and PIN III.

Peoscopic diagnosis of flat condyloma and penile intraepithelial neoplasia. IV. Urethral reservoir.

The aim of the present study was to test the method of urethral cytologic sampling and to assess its results in the cytologic detection of human papillomavirus infection in the male partners of infected women. Cytologic evidence of abnormal epithelium was found in a total of 50 out of 167 cases (29.94%). It is interesting to note that 9 (5.38%) patients with cytological evidence of flat condylomas of the urethra did not have any other lesion. On the basis of the present study, we conclude that cytobrush urethral cytology should be routinely associated with peoscopy in studying the male partners of women affected by human papillomavirus infection, in an effort to diminish the reservoir of a virus strongly associated with cervical and penile neoplasia.

Treatment of men with flat (FC) or acuminata (CA) condylomata with interferon alpha-2a.

This study was undertaken to assess the effect of CO2 laser vaporization, 5-fluorouracil 5% (5-FU) topical application and Interferon alpha-2a (IFA alpha-2a) in the treatment of C.A. or F.C. of the male genital tract. From March 1986 to September 1991, 1372 men, sexual partners of women with F.C. or C.A. or cervical intraepithelial neoplasia, were submitted to peoscopy. One thousand and nineteen (74.27%) men presented with various penile lesions caused by HPV (histologically confirmed); of these 505 were treated for C.A. or F.C. or a combination of F.C. and C.A. The best treatment modalities, irrespective of the kind of lesion, were found to be the combination of 5-FU plus IFN alpha-2a (high dose) (98.27%), the combination of CO2 laser vaporization plus 5-FU plus IFN alpha-2a (high dose) (93.93%) and the combination of CO2 laser vaporization plus 5-FU (87.23%). In conclusion we believe that IFN alpha-2a can be used with excellent results as first line treatment in combination with CO2 laser vaporization or/plus 5-FU in patients with C.A. or F.C. or combined condylomata.

Treatment of cervical intraepithelial neoplasia (CIN) with interferon alpha-2a, CO2 laser (vaporization, cone) and 5-fluorouracil.

This study was undertaken to assess the effect of CO2 laser (vaporization, conization), 5-FU topical application and interferon alpha-2a parenterally in the therapy of GIN. Three hundred and forty-seven (347) women with CIN were treated with CO2 laser (vaporization, conization), 5-FU topical application and interferon alpha-2a parenterally. The cure rates in the various treatment groups were analysed by the chi(2) test. The most effective treatment used for CIN I was the combination of CO2 laser vaporization plus 5-FU (p<0.05). The most effective treatment used for CIN II was the combination of CO2 laser vaporization plus 5-FU (p<0.001). The treatment modalities used for patients with CIN III achieved the same therapeutic results (p>0.1). The addition of interferon does not achieve better cure rates in patients with CIN.

Peoscopic diagnosis of flat condyloma and penile intraepithelial neoplasia V scrotal reservoir.

The aim of the present study was to evaluate prospectively male sexual partners of women with flat condyloma (FC) or accuminata (CA) or cervical intraepithelial neoplasia (CIN) and to determine the incidence of scrotal involvement by HPV. Of the 218 patients, 20 (9.17%) revealed areas of acetowhite epithelium involving the anterior lateral and superior aspects of the scrotum. Eight patients (40%) also presented concomitant small telangiectatic lesions measuring 1-3 mm of the scrotum in the acetowhite areas, and one patient presented scrotal intraepithelial neoplasia grade I (SIN I). The new combination treatment schedule (cream 5-fluorouracil 5% + Interferon alpha-2 alpha) resulted in a 100% cure rate, with no recurrences for the follow-up period (11.52 months). Concluding, the scrotum appears to be an important and presently overlooked area in the evaluation of male patients, and interferon in combination with 5-FU cream seems to be a promising treatment for HPV infection.

Treatment of flat or accuminata condylomata of the female genital tract with interferon alpha-2 alpha.

This study was undertaken to assess the effectiveness of Interferon administered parenterally in the treatment of flat or accuminata condylomata of the female genital tract. One hundred and forty-three women with condylomata were treated with CO2 laser vaporization, 5-FU topical application and interferon alpha-2 alpha (IFN alpha-2 alpha) parenterally. The cure rates in the various treatment groups were analysed by the chi-square test. The cure rates of the treatments used in the patients with condylomata accuminata were similar (p>0.1). The best cure rate for flat condylomata was achieved with the combination of CO2 laser vaporization plus 5-FU plus IFN alpha-2 alpha (high dose) (p<0.01). In conclusion, Interferon can be used as adjuvant treatment in patients with recalcitrant condylomata accuminata and as first line treatment in combination with 5-FU and CO2 laser vaporization in patients with flat condylomata.

Treatment of urethral condylomata acuminata or flat condylomata with interferon-alpha 2a.

The effectiveness of intraurethral 5-fluorouracil and systemic administration of interferon-alpha 2a in the therapy of condylomata acuminata or flat condylomata of the urethra is assessed. From March 1986 to September 1991, 1,372 male sexual partners of women with condylomata acuminata, flat condylomata or cervical intraepithelial neoplasia underwent urethroscopy and brush cytological examination of the urethra. Of these men 305 (22.23%) had intraepithelial human papillomavirus (confirmed cytologically) and 284 were treated. The best treatment modalities, regardless of the type of lesion, were the combinations of 5-fluorouracil plus high (95.34%) and low (70.58%) dose interferon-alpha 2a. Interferon-alpha 2a can be used as first line treatment with 5-fluorouracil cream in patients with intraurethral condylomata acuminata or flat condylomata.

Prenatal diagnosis of fetal urinary pathology with ultrasound.

Forty-six cases of fetal urinary malformations diagnosed by ultrasound are described. A reliable prenatal diagnosis is extremely important since it may offer options for pregnancy termination or may change obstetric management in the third trimester. Ultrasound criteria necessary for the diagnosis are: (i) bilateral multicystic kidneys, (ii) loss of renal architecture, (iii) non-visualization of the fetal bladder, (iv) absence of amniotic fluid, and (v) urinary dilatation. Thirty-six of the 46 cases of fetal urinary pathology had postnatal confirmation of the diagnosis. No false positive diagnosis was observed. All 19 fetuses with obstructive uropathy were observed for more than 3 weeks. Postnatal function was normal in 12 (63%) fetuses with obstructive uropathy. It is concluded that ultrasound is a valuable tool in the detection of fetal urinary pathology.

Nasal septum deformity in the newborn infant during labour.

The incidence of nasal septum dislocation (NSD) was studied in 447 newborns and was found to be 17%. The aim of this study was to establish its aetiology as well as to find ways of prevention and early diagnosis of this obstetrical injury. The following conclusions were drawn: (a) The high frequency of NSD is due to the inadequate support technique (Playfair manoeuvre) currently in use. This is true even when birth weight is normal or less than normal. (b) The severity of injury is lessened by the degree of experience of the obstetrician. This is why NSD is characterised as an obstetrical injury. (c) NSD to the right is more frequent in the front left position of occipital presentation. (d) NSD is more frequent in the anterior part of the nose because the injury is sustained by the anterior part of the septum. (e) The frequency of NSD was not higher in classical forceps delivery, in caesarean section, and in spontaneous delivery. (f) No statistically significant correlation was found between the duration of expulsion and nasal septum dislocation (chi 2 = 4.43, p greater than 0.1). Due to present conditions, a general rhinological examination of all neonates is necessary. The use of Metzenbaum's sign (asymmetry of nostrils) and Jeppesen and Windfeld's test (pressure on the tip of the nose), along with rhinoscopy are recommended. Early diagnosis and treatment of NSD is of great importance, since all complications arising from this obstetrical injury can be prevented and normal function of the nose restored.