Verrucous carcinoma of the cervix--diagnostic and therapeutic difficulties with regards to HPV status. Case report.

Verrucous carcinoma of the cervix is of special interest because of its rare occurrence and frequently existing difficulties in the differential diagnosis, which in verrucous disease eventually leads to a final, more favorable diagnosis. We present a case report of cervical verrucous carcinoma as a rare variant of squamous cell carcinoma in a 65-year-old woman who underwent total hysterectomy based on initial histological diagnosis of cervical dysplasia. Special attention is focused on clinical assessment of the lesion with the depicted restriction of exfoliated cytology as well as misdiagnoses of inappropriately taken, even colposcopically directed biopsy, not covering a full thickness of biopsied tissue. The macro- and micromorphologic similarities of cervical verrucous carcinoma with condylomata acuminata on one hand and invasive squamous cell carcinoma on the other, inclined us to search for a common factor causing human papillomavirus infection.

[Influence of hormonal replacement therapy on bacterial vaginosis in the group of peri- and postmenopausal women]. / Wplyw hormonalnej terapii zastepczej na biocenoze pochwy kobiet w okresie okolo- i postmenopauzalnym.

The aim of the study was to evaluate microbiological biocenosis of the menopausal or postmenopausal women, and women having local hormonal therapy (Ovestin and Ortho-Gynest D). The study group consisted of 123 women (aged 45-72), who underwent clinical examination and microbiological evaluation of vaginal discharge. Miller's and Gramm's methods were used for slide staining and the culture method for growing microorganisms. Classical culture media were used as well as Rogosa culture medium and modified Weinstein medium for Lactobacillus culture in anaerobic conditions. In the microbiological studies before initiation of hormonal therapy, normal biocenosis of the vagina was found in 52 women (42.27%). The other part of the study group had abnormal vaginal biocenosis or had no microorganisms at all. During the hormonal therapy, the group of women with normal biocenosis increased to 53.65% and 62.29% after respectively 3 and 9 months of therapy. Hormonal therapy secured continuity of normal Lactobacillus morphotypes within perimenopausal period. Antimicrobial and hormonal therapies used together provided normalization of vaginal biocenosis in a shorter time. In the group of senile women, the recolonization of vaginal mucosa by Lactobacillus vaginalis was observed.

The potential role of the esophageal pre-epithelial barrier components in the maintenance of integrity of the esophageal mucosa in patients with endoscopically negative gastroesophageal reflux disease.

OBJECTIVE: Patients with gastroesophageal reflux disease (GERD) accompanied by erosive reflux esophagitis (RE) exhibit an impairment within the esophageal pre-epithelial barrier protective components that may facilitate the development and/or progression of the mucosal injury. Little is known, however, whether such impairment is a general phenomenon affecting all patients with GERD or whether this is a characteristic feature only of patients with erosive RE. We therefore studied the rate of secretion of esophageal inorganic and organic protective factors in patients with endoscopically negative [E (-)] GERD and compared these results with the corresponding values in asymptomatic volunteers (CTRL). METHODS: The study was conducted on 33 white asymptomatic volunteers and 10 white patients with a long history of GERD confirmed by 24-h pH monitoring and a grossly negative upper endoscopy. Esophageal secretion was collected during mucosal exposure to NaCl, HCl, HC/pepsin and NaCl using the esophageal perfusion catheter. In collected samples all investigated parameters were measured. RESULTS: The pH of esophageal secretion and its content of bicarbonate, EGF, and PGE2 in patients with E (-) GERD and asymptomatic volunteers were similar. Unexpectedly, the rate of esophageal glycoconjugate (predominantly mucin) secretion was significantly higher in patients with E (-) GERD than in controls during perfusion with HCl (p < 0.05). Furthermore, secretion of protein in patients with E (-) GERD was significantly higher than in the control group during the mucosal exposure to HCl/Pepsin (p < 0.05). The nonbicarbonate buffer secretion during perfusion with HCl and HCl/Pepsin as well as the rate of esophageal TGFalpha output during infusion of final saline in patients with E (-) GERD were significantly lower than in CTRL group (p < 0.05). CONCLUSIONS: Our data indicate that patients with E (-) GERD have an esophageal secretory potential, in terms of glycoconjugate and protein, higher than that in asymptomatic controls. This phenomenon in patients with E (-) GERD may, by enhancing the quantity of the esophageal pre-epithelial barrier, help to prevent the development of erosive esophagitis. A significantly lower esophageal secretory response in patients with E (-) GERD in terms of nonbicarbonate buffers and TGFalpha may facilitate the development of GERD symptoms and histological changes of GERD, respectively.

[The effectiveness of conservative treatment of cervical lesions using the LLETZ and CO2 laser]. / Skutecznosc oszczedzajacego leczenia zmian szyjki macicy przy zastosowaniu procedury LLETZ oraz waporyzacyjnego lasera CO2.

Development made on the carcinogenesis process of the cervical lesions and increased detection of the early precancerous lesions enable discontinuance of radical treatments for non-radical techniques which it is of vital importance to young women of the child-bearing capacity. The aim of this study was to determine the efficacy of the non-radical treatment of the cervical lesions using LLETZ procedure (Large Loop Excision of Transition Zone) and laser CO2 vaporisation. 2046 women aged 18-46 who were diagnosed for cervical lesions were treated in the Institute of Obstetrics and Gynaecology Medical School of Bialystok in the years 1994-97. 216 of which were histologically confirmed for CIN I-III diagnosis. The choice between LLETZ or laser CO2 was made based on a pre-treatment examination (cytology, colposcopy, microbiology test and punch biopsy). The final results were evaluated from 6 months to 4 years after the treatment. The effectiveness of CO2 laser was 94.6% and was similar to LLETZ--96.4%. In spite of almost complete agreement in both procedures, the LLETZ seems to be more preferred because of the possibility of histological post-treatment verification.

Esophagoprotective potential of cisapride. An additional benefit for gastroesophageal reflux disease.

Cisapride is a novel prokinetic agent that releases acetylcholine at the level of the myenteric plexus. Acetylcholine also plays a role in the secretory function of salivary glands evoked by intraesophagal mechanical and chemical stimulation, mediated through the esophagosalivary reflex. The impact, however, of cisapride on salivary protective components mediated by esophagosalivary reflex remains unknown. Therefore, we have studied salivary pH, bicarbonate, nonbicarbonate, glycoconjugate, protein, EGF, TGF-alpha, and PGE2 before and after the administration of cisapride. The study was conducted in 20 asymptomatic volunteers (9 women and 11 men, mean age 36, range 26-52). Salivary secretions were collected under basal conditions and during masticatory, mechanical, and chemical stimulation before and after four days of cisapride administration (10 or 20 mg four times a day). Cisapride administration resulted in a 45% increase in salivary volume during the basal condition (P < 0.01), a 32% increase during mastication (P < 0.05), a 53% increase during mechanical (P < 0.05), and a 51% increase during chemical (P < 0.01) stimulation. Cisapride administration resulted also in a significant increase in salivary protein output (P < 0.05), salivary bicarbonate (P < 0.05), and nonbicarbonate buffers (P < 0.05), and salivary EGF (P < 0.05). Salivary glycoconjugate significantly increased only during mechanical stimulation with the catheter and at the end of the esophageal perfusion procedure (P < 0.05). Although a similar trend was also recorded during the analysis of salivary PGE2, this difference did not reach statistical significance. Salivary pH and TGF-alpha before and after cisapride administration remained unchanged. The stimulatory impact of cisapride on salivary volume and inorganic (bicarbonate and nonbicarbonate buffers) and organic (protein, glycoconjugate, and EGF) protective components would benefit patients with GERD and would also be potential therapy for xerostomia.