Kinetics of DNA load predict HPV 16 viral clearance.

INTRODUCTION: While high HPV 16 viral load measured at a single time point is associated with cervical disease outcomes, few studies have assessed changes in HPV 16 viral load on viral clearance. OBJECTIVE: To measure the association between changes in HPV 16 viral load and viral clearance in a cohort of Thai women infected with HPV 16. STUDY DESIGN: Fifty women (n=50) between the ages of 18-35 years enrolled in a prospective cohort study were followed up every three months for two years. Women positive for HPV 16 DNA by multiplex TaqMan assay at two or more study visits were selected for viral load quantitation using a type-specific TaqMan based real-time PCR assay. The strength of the association of change in viral load between two visits and viral clearance at the subsequent visit was assessed using a GEE model for binary outcomes. RESULTS: At study entry, HPV 16 viral load did not vary by infection outcome. A >2 log decline in viral load across two study visits was found to be strongly associated with viral clearance (AOR: 5.5, 95% CI: 1.4-21.3). HPV 16 viral load measured at a single time point was not associated with viral clearance. CONCLUSIONS: These results demonstrate that repeated measurement of HPV 16 viral load may be a useful predictor in determining the outcome of early endpoints of viral infection.

Accuracy of intraoperative frozen section in diagnosis of ovarian tumors.

OBJECTIVE: To determine the accuracy of intraoperative frozen section diagnosis of ovarian tumors according to malignancy status. MATERIAL AND METHOD: From May, 1999 to October, 2004 at Songklanagarind Hospital, a total of 229 ovarian specimens were transferred from the operating room to the Department of Pathology for intraoperative frozen section. All cases of deferred diagnosis and disagreement between frozen and permanent paraffin section were reviewed. RESULTS: Intraoperative frozen section diagnosis of all 229 ovarian specimens revealed 54.1% benign tumors, 8.3% borderline tumors, 30.6% malignant tumors, and 7% deferred diagnoses. The final paraffin section diagnoses revealed 52.4% benign tumors, 9.2% borderline tumors, and 38.4% malignant tumors. Mean tumor diameter of the agreement cases were 12.58 +/- 5.39 cm, disagreement cases were 17.64 +/- 6.83 cm, and deferred cases were 19.33 +/- 6.50 cm. The mean diameter of mucinous tumors was significantly different comparing between disagreement cases to agreement cases and deferred cases to agreement cases. The overall accuracy was 89.7%. Sensitivity was highest in the benign group at 98.2% and lowest in the borderline group at 57.1%. The sensitivity and specificity for benign, borderline, and malignant tumors were 98.2%, 57.1%, 86.1%, and 87.0%, 96.4%, 98.5%, respectively. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for benign, borderline, malignant tumors were 89.5%, 63.2%, 97.1% and 97.8%, 95.4%, 92.3%, respectively. CONCLUSION: Intraoperative frozen section diagnosis appears to be an accurate technique for the histopathologic diagnosis of ovarian tumors. However, limitations in use of frozen section must be recognized such as large specimens, especially mucinous subtype. Regular re-evaluation or consultation concerning disagreements between frozen section diagnosis and final permanent paraffin diagnosis should be conducted by both surgeons and pathologists as part of quality assurance to determine the most appropriate intraoperative management for patients with ovarian tumors.

Misoprostol for cervical ripening in non-pregnant women: a randomized double-blind controlled trial of oral versus vaginal regimens.

BACKGROUND: The objective was to compare the efficacy of oral versus vaginal misoprostol for cervical ripening in non-pregnant women. METHODS: Sixty non-pregnant women scheduled for diagnostic hysteroscopy were randomized by computerized randomization schedule to 400 microg of misoprostol orally (n = 30) or 200 microg vaginally (n = 30) administered 12 h prior to surgery. The diameter of the cervical canal measured with a Hegar dilator, adverse events and any complications were recorded and compared between the two groups. RESULTS: The mean pre- and post-medication cervical canal diameter and cervical diameter difference were 2.00 +/- 1.93 versus 2.37 +/- 1.83 mm (P = 0.453), 5.10 +/- 1.75 versus 5.60 +/- 1.69 mm (P = 0.265) and 3.10 +/- 1.79 versus 3.23 +/- 1.74 mm (P = 0.771) in the oral and vaginal group, respectively. Seven patients in the oral group and one patient in the vaginal group experienced diarrhoea within 24 h of administration of the misoprostol. CONCLUSION: Oral misoprostol 400 microg had similar efficacy in cervical ripening to 200 microg of vaginal misoprostol.

Prolonged remission of endometrial cancer with paclitaxel and carboplatin.

Recurrent endometrial cancer has grave prognosis. Chemotherapy and hormonal therapy are mainstays of palliative treatment. Unfortunately the frequency of complete response and duration of progression-free interval are limited. This case report describes a patient with recurrent metastatic endometrial cancer who was initially treated with radiotherapy followed by surgery. Her recurrent tumor progressed during treatment with external radiation and a progestogen. She received paclitaxel (135 mg/m2 i.v. infusion over 24 h) and carboplatin (AUC 7.5 microg x h/ml) every 4 weeks with complete remission after 8 months which has persisted for 22 months. Paclitaxel and carboplatin combination should be considered for the treatment of endometrial cancer.