External quality assurance in cervical/vaginal cytology: Interlaboratory agreement in the Emilia-Romagna region of Italy.

OBJECTIVE: To evaluate the diagnostic agreement between seven cervical/vaginal cytology laboratories participating in the first external quality assurance (EQA) scheme developed in Italy. STUDY DESIGN: Between 1991 and 1993, 110 cytologic smears were selected and classified by a committee and circulated and reported on by the laboratories according to the 1988 Bethesda System. Agreement was evaluated with the kappa statistic. Systematic disagreement was assessed by means of the Wilcoxon signed rank test. RESULTS: Interlaboratory kappa values varied between .01 and .29 (group score, .11) for sample adequacy and between .53 and .78 (group score, .67) for epithelial abnormalities. The lowest specific kappa values were observed for the three classes of sample adequacy (unsatisfactory, .07; less than optimal [LTO], .10; satisfactory [SAT], .14) and for the class of atypical cells of undetermined significance (ACUS), (.29). As compared with the study committee, 5/7 laboratories showed a systematic (P<.01) tendency to undercall sample adequacy. Agreement on epithelial abnormalities was also analyzed according to the pattern of adequacy reported by paired laboratories (LTO/LTO, LTO/SAT, SAT/SAT). As compared with smears designated SAT/SAT, those classified as LTO/SAT were associated with lower specific kappa values for agreement on the presence of carcinoma and ACUS and with equal or greater values for agreement on the other classes, suggesting an arbitrary use of notations of LTO inversely related to the severity of epithelial lesions. CONCLUSION: EQA schemes, as applied to cervical/vaginal cytology, can shed light on major deficiencies in specific diagnostic areas.

Modification of number and of affinity of endometrial EGF receptors during the menstrual cycle.

We have analysed the distribution and the binding properties of the epidermal growth factor (EGF) receptor in human endometrium during the menstrual cycle to validate the proposal that steroids affect the growth rate of target cells via growth factor-related pathways. The total number of EGF receptors and their affinity for the iodinate exogenous ligand are significantly higher during the proliferative than the secretory phase; the binding kinetics appear to be hyperbolic and sigmoid during the proliferative and the secretory phase, respectively. These results suggest that endogenous sex steroids can regulate the levels and the properties of EGF receptors in vivo, and support the possibility that receptor-coupled events may play a role in estrogen-stimulated growth.

Sequences homologous to two separate transforming regions of herpes simplex virus DNA are linked in two human genital tumors.

Ten human genital invasive squamous cell carcinomas and five human premalignant tissues were analyzed for the presence of selected sets of herpes simplex virus 2 (HSV-2) DNA sequences. Two vulvar tumors and one vulvar dysplastic tissue were found to contain DNA sequences homologous to the BglII O fragment (coordinates 0.38-0.42) and the BglII N fragment (coordinates 0.58-0.63) of HSV-2 DNA. These two fragments overlap the subsets of HSV-1 and HSV-2 DNA sequences (respectively) shown previously to transform cells in culture. Sequences homologous to an additional HSV-2 DNA probe (BglII G) were not detected in the same tumors. Surprisingly, in each of the two positive vulvar tumors, the BglII N and BglII O sequences appeared to be linked, whereas in the standard HSV-2 genome the two fragments are separated by approximately 26 kb. This finding suggested that the two sets of sequences may have rearranged prior to or following the association of the HSV DNA sequences with the tumor cells. The same set of 10 tumors were analyzed for the presence of sequences complementary to human papillomavirus 16 (HPV16) DNA. The HPV16 DNA probe hybridized to three of six cervical tumors, whereas no hybridization was detected with the two vulvar tumors which contained the HSV DNA sequences.

Search for HSV DNA in genital, cerebral and labial tumors.

DNA sequences homologous to HSV-1 and HSV-2 DNA fragments were searched in 64 genital, 35 labial and 34 cerebral tumors. Southern blot transfers of tumor and control DNAs were hybridized in stringent conditions with 32P labelled probes from HSV-1 and HSV-2 cloned DNA fragments. Specific hybridization to HSV-2 BglII N fragment was observed in six (9.4%) genital tumors. Labial and cerebral tumors did not show hybridization to any of the probes used. The technique employed allowed the detection of 0.1 copies of viral fragments per diploid genome.

Hormonal sensitivity of adenylate cyclase from human endometrium: modulation by estradiol.

In human endometria, a membrane-bound adenylate cyclase is present, which is recovered in high yield in a low-speed particulate fraction. Neither the specific activity of the enzyme nor the response to modifiers that act through the regulatory subunit of the complex, are modified during the proliferative or secretory phase of the cycle. Surprisingly, we found that in vitro treatment of secretory endometrial membranes with 17 beta-estradiol stimulates 3- to 4-fold the activity of adenylate cyclase. However this response does not occur on proliferative membranes. The activation by estradiol is independent of the presence of guanylylimidodiphosphate and is additive to that of the nucleotide. Possibly, as the consequence of the phenomenon, the concentration of cyclic AMP is significantly higher in curretage samples obtained from patients during the secretory rather than in the proliferative phase of the cycle. To our knowledge this is the first evidence of a target-cell membrane-directed effect of sex steroids in humans.

Primary carcinoma of the Bartholin gland.

The authors report a case of primary carcinoma of the Bartholin gland treated with a radical vulvectomy and bilateral inguinal lymphadenectomy.

[Saprophytic and opportunistic non spore-forming anaerobic microflora of the vagina (author's transl)]. / Commensalismo ed opportunismo della flora anaerobia non sporigena della vagina.

A microbiological survey has been carried out on 179 healthy, child-bearing aged, non-pregnant women, with the aim to evaluate the incidence of anaerobic non-spore forming bacteria in the normal vaginal flora. This group of bacteria has been isolated in 50.3% of women, with a clear prevalence of "anaerobic Streptococci " and Bacteroides, followed by Fusobacterium and Veillonella. No Propionibacterium, Eubacterium or Bifidobacterium have been isolated. According to many Authors the non-spore forming anaerobes must be considered opportunistic bacteria, responsible of many infections of the female genital tract, especially when associated with other aerobic or facultative bacteria. Antibiograms have demonstrated a wide spectrum of activity of chloramphenicol and clindamycin; although not widely distributed, antibacterial activity have also shown metronidazole, penicillins, cephalosporins and lincomycin.

Congenital malformations observed at the obstetric department of Ferrara from 1973 to 1978.

The Authors illustrate the results of a clinicostatistical research conducted on 139 cases of malformations corresponding to 13.07% of 10.633 births of the Obstetric Clinic of Ferrara during the period 1973-1978. The following variables were examined: type of malformation, sex, wight, duration of pregnancy, type of delivery, mother's age and order of birth.