[Detection of HPV DNA in lymph nodes in early stages cervical cancers]. / Stanovení DNA HPV v lymfatických uzlinách u casných stadií karcinomu delozního hrdla.

OBJECTIVE: Review recent knowledge concerning significance of detection of DNA HPV in regional lymph nodes in cervical cancer patients. TYPE OF THE STUDY: Literature review. SETTING: Department of Obstetrics and Gyneacology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague. RESULTS: Metastatic involvement of pelvic lymph nodes is the most important prognostic parameter in early stages cervical cancer. Still, almost 20% of patients with negative pelvic nodes experience recurrence. Detection of HPV DNA in lymph nodes might be a marker of occult metastatic involvement. However, published data are limited, mostly due to inconsistent methodology. Only 3 prospective studies evaluating HPV from fresh or frozen tissue were published till now, all other retrospective studies extracted HPV DNA from paraffin embedded samples. A few papers showed correlation between HPV DNA and metastatic involvement of pelvic lymph nodes. DNA HPV identification in histopatology-negative nodes was considered as a risk factor for recurrence. Presence of DNA HPV 18 in histopathology-negative pelvic nodes was described as a poor prognostic factor; however prognostic significance of individual genotype is still unclear. CONCLUSION: Detection of high risk HPV DNA in regional lymph nodes is a good candidate for prognostic parameter in early stages cervical cancers. The group of women with both absence of metastatic involvement and negative HPV DNA evaluation of regional lymph node should represent a cohort of patients with particularly good prognosis.

[Genotyping of CYP2D6 and CYP2C19]. / Genotypizace cytochromu P450 2D6 a 2C19.

BACKGROUND: Polymorphisms in drug metabolizing enzymes are considered as a major factor influencing the incidence of adverse drug reactions or failure of pharmacotherapy. Our aim was to compare the distribution of functional polymorphisms in the genes CYP2D6 and CYP2C19 between healthy control group and of patients reffered to our department due to adverse drug reactions or insufficient efficacy of a treatment. METHODS AND RESULTS: The group of patients comprised of 60 subjects, 218 healthy unrelated subjects were included in the cotrol group. In both groups genotypes of CYP2D6 and CYP2C19 were analyzed. There were significantly fewer extensive metabolizers of CYP2D6 in the patient group comparison with healthy control subjects (25.0% vs. 49.8%) while the proportion of intermediate metabolizers was significantly higher than in helthy population (58.3% vs. 38.5%). We also observed more poor metabolizers than in control group (13.3% vs. 6.8%), but the difference did not reach level of statistical significance probably due to low number of subjects. The distribution of either ultrarapid metabolizers of CYP2D6 or deficient alleles of CYP2C19 was similar in both groups. CONCLUSIONS: Clinically apparent alteration of drug effects are often caused by partial or complete deficit of CYP2D6 activity. Our results confirm the importance of CYP2D6 polymorphisms on the efficycy and safety of pharmacotherapy.

[Cervical cancer precursors: cytohistologic correlation with the results of HPV testing]. / Prekurzorové léze karcinomu delozního cípku: korelace cytologických a histologických nálezu s výsledkem HPV testu.

Persistence of high-risk types of human papillomavirus (HPV) is responsible for the development, maintenance and progression of squamous intraepithelial lesions (SILs). Cytohistologic correlation with the results of the HPV testing in 52 patients over a 3year period is presented. Two patients out of the 52 patients presented in this histologic follow up bore the diagnosis high-grade squamous intraepithelial lesion (HSIL) with the former cytology ASC-H. Low grade squamous intraepithelial lesions (LSIL) were found in eight patients, half of them diagnosed identically on cytology. Another four cases were formerly diagnosed cytologically as ASC-US. All women with the histologically confirmed dysplastic changes were HR HPV DNA positive. Our results indicate that significant histologic lesions may be discovered in patients exhibiting the high-risk HPV DNA positivity in the category of ASC-US (Atypical Squamous Cells of Undetermined Significance) and especially ASC-H (ASC cannot exclude high-grade squamous intraepithelial lesion). A combined screening test thus offers the possibility of greater protection and /or longer screening intervals.

[Noninvasive screening for genital chlamydiosis in adolescents in Brno]. / Neinvazivní screeningové vysetrení genitální chlamydiózy adolescentu mesta Brna.

OBJECTIVE: To run a screening for genital chlamydiosis in adolescents living in the town Brno as the first action of this type in the Czech Republic and to use the results of the screening for the elaboration of recommendations for running similar actions on the national scale. DESIGN: Prospective epidemiological study. SETTING: Veterinary Research Institute, Brno; Institute of Clinical Biochemistry, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague; Section of Public Health, Municipal Authorities of Brno; Bioplus Ltd., Brno; Regional Hygienic Services, Brno; Faculty Hospital Brno; with technical assistance of teachers and students of two Medical Assistant Schools in Brno. METHODS: Students (337 females and 15 males) of two Medical Assistant Schools, older than 18 years, were used as probands within the study. Sediments of the first portions of urine collected from the individual probands were tested for the presence of Chlamydia trachomatis using the direct fluorescent test, ELISA, and the ligase chain reaction. RESULTS: Positive reactions in any of the three tests were found in 31 of the 352 probands (8.8%). Positive and doubtful reactions in the direct fluorescent antibody test were obtained in 11 (35.5%) and 3 (9.6%) of the 31 reactors, respectively. The corresponding values for ELISA were 9 (23.0%) and 8 (25.8%), respectively, and those for the ligase chain reaction 3 (16.6%) and 3 (16.6%), respectively. The overall prevalence of 8.8% is higher than the European mean. CONCLUSIONS: The first limited screening for genital Chlamydia infections in the Czech Republic was run in Brno. Urinary samples were collected from 337 females and 15 males aged approximately 18 years. The presence of Chlamydia trachomatis in the urinary sediment was demonstrated by the direct fluorescent test, ELISA, and the ligase chain reaction. The established prevalence of 8.8% exceeded the European mean (3.9%).

[Chlamydia trachomatis in men with impaired fertility]. / Chlamydia trachomatis u muzu s poruchou plodnosti.

OBJECTIVE: The objective of the prospective study was to assess whether there exists a relationship between the results of positive laboratory tests for the presence of Chlamydia infection (assessment of the presence of Chlamydia trachomatis in the ejaculate by the DNA amplification method, IgA and IgG antichlamydia antibodies in the ejaculate and serum), an abnormal spermiogram and total number of sexual partners in men from infertile couples examined at the Gynaecological and Obstetric Clinic of the First Medical Faculty, Charles University Prague. DESIGN: Prospective clinical study. SETTING: Department of Gynaec.-Obstet., the 1st Medical Faculty of the Charles University, Prague, Czech Republic--Institut of Clinical Biochemy, the 1st Medical Faculty of Charles University, Prague, Czech Republic. METHOD: 101 men were examined. In all the spermiogram was evaluated according to WHO criteria. Specific antichlamydial antibodies IgA and IgG is serum and the ejaculate were assessed by the ELISA method. Evidence of the DNA portion of Chlamydia trachomatis was provided by the MEIA method. Amplification of DNA by LCR was made on a Thermocycler. By means of an aimed questionnaire the number of all sexual partners was assessed. The men were divided into three groups with 1-5, 6-9 and with 10 or more partners. Patients where Chlamydia infection was detected were treated with Ig Azitromycin and their spermiogram was checked 6-8 weeks after treatment. The results of the examination were tested by the chi square test. RESULTS: An abnormal spermiogram was found in 44 (44%) of the examined subjects. With the increasing number of sexual partners the number of men with pathospermia increased. In none LCR for the presence of Chlamydia trachomatis was positive in the ejaculate. In 15 examined patients IgA antichlamydia antibodies were found in the ejaculate. At the same time in all an abnormal spermiogram was found and 11 (73%) of them had six or more sexual partners. After treatment in 8 (62%) of 13 (two did not attend the check-up) marked improvement of the spermiogram occurred. CONCLUSION: IgA antichlamydial antibodies in the ejaculate proved in 62% of the examined men with an abnormal spermiogram a useful indicator of infection in the genital tract. With the increasing number of sexual partners the number of pathospermias increased.

[Prevalence of HPV infection and histologic correlations]. / Prevalence HPV infekce a její histologické korelace.

476 patients with cervical lesions were examined for HPV presence in the lower genital tract. The ViraPap/ViraType detection set was used. Prevalence of low oncogenic risk group of HPV types (LR-HPV) was 12.2% a that of intermediate and high risk group (HR-HPV) was 28.5%. It is compared with control series of 168 women undergoing interruption of pregnancy (prevalence of LR-HPV 3.0% and of HR-HPV 13.7%) and with a control series of 137 STD (sexually transmitted disease) bearers (prevalence of LR-HPV 3.6% and of HR-HPV 19.0%). HR-HPV positivity was found in 37.8% of patients with CIN I, 46.7% with CIN II and 35.3% with CIN III. 16 of 20 cases (80%) with invasive cervical cancer were HR-HPV positive. The authors confirmed a statistically significant difference of HR-HPV positivity between series of women with interruption of pregnancy, with CIN and with invasive cervical cancer. Among HR-HPV positive cases, 76.5% had CIN or invasive cancer of cervix. The role of HPV testing in clinical management of cervical lesions is evaluated and considered meaningful by authors.

[Diagnosis of human papillomaviruses in the lower genital tract using the ViraPap/ViraType detection kit]. / Diagnostika lidských papilomaviru v dolním genitálním traktu detekcním setem ViraPap/ViraType.

The authors investigated a group of 195 patients from the Centre of Oncological Prevention for human papillomavirus (HPV) in the lower genital tract. The diagnostic set ViraPap/ViraType was used for detection. It is based on double hybridisation of viral DNA and on the use of polyclonal and monoclonal antibodies with chemoluminiscent reaction. The test was totally positive in 23.1% of women. 5.1% tests were positive in the low-risk group of viruses (LR-HPV) and 19.5% in the high risk group (HR-HPV). Precancerous lesions (CIN I-III) or invasive cancer were found in 86.7% of positive tests. In patients with CIN III 37.1% were HPV positive and all patients with invasive cancer were positive. The results support an association between CIN and HPV infections. The possible role of HPV in cancerogenesis is discussed as well as the clinical importance of their detection.