Prevalence of acetowhite areas in male partners of women affected by HPV and squamous intra-epithelial lesions (SIL) and their prognostic significance. A multicenter study.

BACKGROUND: Estimates for the prevalence of cervical HPV infection vary and are only available for a few populations with regard to male partners. Attention has been drawn to the male role in cancer progression from cervical intra-epithelial neoplasia, but most of the male lesions are subclinical and only visible after acetowhite staining. The prognostic significance of acetowhite areas, of male partners of women affected by HPV and preneoplastic lesions, was evaluated. MATERIALS AND METHODS: A cohort of 3210 male partners of women affected by HPV infection and/or preneoplastic lesion of the lower genital tract was observed from 1987 to 2001. Acetowhite changes were assessed 5 min after the application of 5% solution of acetic acid and biopsies were tested for HPV-DNA by PCR. Patients with HPV lesions underwent CO2 laser surgery and follow-up. RESULTS: Of the 3210 male partners, 39.12% exhibited clinical HPV lesions and 3.64% subclinical lesions identified as acetowhite areas. In the group of 117 male partners with acetowhite areas, the HPV-DNA test was positive (HPV 6-11) in 36.75% and negative in 63.24% (p<0.001). No statistical differences were observed between HPV+/- groups regarding their sexual habits. The HPV-positive infection group compared to the HPV-negative group showed a statistically significant difference for CO2 laser surgery (p<0.001). CONCLUSION: The acetic acid test can give false-positives and is not a specific indicator of HPV infection, and thus the limited efficacy of tests for acetowhite areas was confirmed. The treatment of clinical lesions is necessary. Follow-up represents the major route to the diagnosis of preneoplastic lesions in men and for the prevention of cervical carcinoma in their female partners.

Follow-up of high-grade squamous intra-epithelial lesions (H-SIls) in human immunodeficiency virus (HIV)-positive and human papillomavirus (HPV)-positive women. analysis of risk factors.

BACKGROUND: Human immunodeficiency virus (HIV)-positive women are at high risk of co-infection from human papillomavirus (HPV) and of developing squamous intraepithelial lesions of the cervix. MATERIALS AND METHODS: From April 1997 to March 1999, 86 women, affected by high-grade squamous intra-epithelial lesions (H-SILs), were enrolled: 41 were HIV+ (CD4+ count >500/ml) and 45 were HIV-. The diagnosis of high-grade squamous intra-epithelial lesion (H-SIL) was established for each patient by Pap test, colposcopy and guided biopsy. For all samples, the HPV/DNA test was also performed by PCR. The patients' lesions and recurrence were treated by cone biopsy or large loop excision (LEEP). Annual controls were performed for 5 years. RESULTS: A high rate of alcohol and drug use (60.7% vs. 31.4%; p=0.004; 80% vs. 27.5%; p<0.001, respectively) and number of male partners (4.5 vs. 3.0; p<0.001) were found in the HIV+ patients, compared to the HIV- patients. Both groups were HPV+ for high-risk types. No difference was found in the percentage of patients who had received a second LEEP. CONCLUSION: Our findings suggest the treatment of H-SIL in HIV-positive women, for a longer disease-free survival, or a lower risk of developing cervical cancer.

Amniotic fluid lamellar body counts for the determination of fetal lung maturity: an update.

AIM: To reassess the cut-off value for lamellar body counts (LBs) for fetal lung maturity (FLM) over a 10-year study period. PATIENTS AND METHODS: 178 pregnancies were selected under strict inclusion criteria and delivered within 48 h from amniocentesis. FLM was determined by amniotic fluid LBs in centrifuged samples (300 x g for 10 min) in a commercially available Coulter Counter. Cases beyond 37 weeks were excluded. RESULTS: Mean gestational age was 33.5+/-3.0 weeks at amniocentesis and 33.7+/-3.0 weeks at birth. After reassessing the best compromise between sensitivity and specificity for all cases using the receiver operating characteristic (ROC) procedure, an FLM cut-off value of < or = 22,000/microL was obtained. Diagnostic accuracy (and confidence interval, CI) was: sensitivity, 73% (60.0-83.6%); specificity, 81.7% (CI 73.6-88.1%); positive predictive value, 66.2%; and negative predictive value, 86.0%. CONCLUSION: No significant change in FLM cut-off for LBs was found when comparing the value from this study and the results of our earlier report presented in 1996 (< or = 22,000 vs. < or = 20,000/microL), although the new value may be more accurate, since it is based on neonatal outcome with the exclusion of cases in which the diagnosis of FLM is seldom warranted, i.e., > 37 weeks' gestational age.

Validity of short term variation (STV) in detection of fetal acidemia.

AIMS: We aimed to establish a cut-off for short term variation (STV) in msec in electronic FHR tracings as a single parameter for the prediction of neonatal acidemia and hypercarbia at birth. METHODS: 195 consecutive cases of singleton pregnancies between 26 to 42 weeks' gestation delivered by cesarean section, with an antepartum tracing performed within 4 hours from birth and umbilical artery gas analysis (UBGA) available at birth. RESULTS: A positive correlation (r = 0.27, p < 0.0001) was found when STV was regressed against gestational age. We also found significant correlations between STV and UBGA parameters (pH [r = 0.12, p < 0.05] and pCO2 [r = -0.17, p < 0.01]). In order to evaluate the influence of gestational age on STV values, we subdivided patients into three subgroups (< 34 weeks: n = 31; 35-37 weeks: n = 37, and > 37 wks: n = 127). Only in the subgroup < 34 wks, STV < 5.1 msec was a significant predictor of acidemia (pH < 7.0), (sensitivity: 100%, specificity: 61%, p < 0.05); in the same subgroup STV < 4.9 msec predicted pCO2 > 60 mmHg with a sensitivity: 71.4% and a specificity: 62.5% (p < 0.02). CONCLUSION: In cases < 34 weeks' gestation, STV values below 4.9 msec and 5.1 msec are able to predict umbilical artery pH < 7.0 and PCO2 > 60 mmHg, respectively.

Intraventricular haemorrhage in a fetus with cerebral cytomegalovirus infection.

Cytomegalovirus (CMV) is the leading infectious cause of prenatal neurological damage, which is particularly severe when primary maternal infection occurs during the first 16 weeks of gestation, at the time of organ development and neuronal migration. Vascular involvement has been suggested to be among the possible pathogenic mechanisms of virus-induced pathology, in addition to direct viral effects. We report on a fetus with cerebral CMV infection, which had intraventricular haemorrhage, together with oligohydramnios and hyperechogenic bowel, following maternal primary CMV infection.

[Drugs and pregnancy]. / Droghe e gravidanza.

The evidence of the transplacental transfer of most of the drugs administered to the mother has changed the old concept of the invulnerability of the fetus due to the placental barrier protection. The commonly used drugs act on the fetus by means of two different mechanisms: directly after the placental transfer, and indirectly influencing the utero-placental circulation and maternal homeostasis. Fetal effects can be several and they depend on the type of the drug, dosage, route of administration, gestational age in relation to the fetal ontogenesis, and on the amount of drug which reaches the fetus. For example, some drugs are redistributed in the maternal compartment; others remain in the fetal compartment by virtue of their chemical-physical characteristics and/or altered fetal homeostasis, i.e., fetal acidosis results in ionisation of the loco-regional anesthetics, which cannot leave the fetus, and therefore are entrapped in the fetal compartment. The complexity of the fetal-maternal pharmacology has implemented research on the animals, and epidemiologic and clinic studies. In spite of the research performed in the last years, the long-term perinatal effects are still to be clarified for many drugs administered to the mother.