High Risk Factors For Recurrence Research Articles

Persistence of human papillomavirus DNA in cervical lesions after tith diathermic large loop excision

Objective The aim of this study was to identify human papillomavirus (HPV) in cervical intraepithelial neoplasia (CIN) lesions and to evaluate the persistence of viral DNA after diathermic large loop excision (DLLE) treatment. Study Design Biopsies from 36 patients with low- and high-grade CIN lesions were studied before and after DLLE treatment looking for HPV sequences. DNA was extracted to perform a radioactive polymerase chain reaction (PCR) using GP 5,6 generic primers. PCR products were analyzed by the single-stranded conformational polymorphism (SSCP) which is a simultaneous detection and typing method. Dot-blot hybridization with generic and type-specific biotinylated oligonucleotide probes was applied in some cases. Results HPV DNA was found in all pretreatment samples, and the viral type was identified in 80% of them, HPV 16 being the most prevalent. The viral type coincided with that detected in the first biopsy in all except one case. Seventy five percent of the patients (27 cases) were negative for CIN at follow up, but 50% of them remained HPV DNA positive. Conclusion DLLE treatment was effective in removing the CIN lesion but not the HPV. This fact points out the need to asses the presence of HPV in DNA during the follow-up, since viral persistence has been considered a high risk factor for recurrence and/or malignant transformation. Infect. Dis. Obstet. Gynecol. 6:214–219, 1998. © 1998 Wiley-Liss, Inc.

Persistence of Human Papillomavirus DNA inCervical Lesions After Treatment With DiathermicLarge Loop Excision

Objective: The aim of this study was to identify human papillomavirus (HPV) in cervical intraepithelial neoplasia (CIN) lesions and to evaluate the persistence of viral DNA after diathermic large loop excision (DLLE) treatment.Study Design: Biopsies from 36 patients with low‐ and high‐grade CIN lesions were studied before and after DLLE treatment looking for HPV sequences. DNA was extracted to perform a radioactive polymerase chain reaction (PCR) using GP 5,6 generic primers. PCR products were analyzed by the single‐stranded conformational polymorphism (SSCP) which is a simultaneous detection and typing method. Dot‐blot hybridization with generic and type‐specific biotinylated oligonucleotide probes was applied in some cases.Results: HPV DNA was found in all pretreatment samples, and the viral type was identified in 80% of them, HPV 16 being the most prevalent. The viral type coincided with that detected in the first biopsy in all except one case. Seventy five percent of the patients (27 cases) were negative for CIN at follow up, but 50% of them remained HPV DNA positive.Conclusion: DLLE treatment was effective in removing the CIN lesion but not the HPV. This fact points out the need to asses the presence of HPV in DNA during the follow‐up, since viral persistence has been considered a high risk factor for recurrence and/or malignant transformation.

Persistence of human papillomavirus DNA in cervical lesions after treatment with diathermic large loop excision.

OBJECTIVE: The aim of this study was to identify human papillomavirus (HPV) in cervical intraepithelial neoplasia (CIN) lesions and to evaluate the persistence of viral DNA after diathermic large loop excision (DLLE) treatment. STUDY DESIGN: Biopsies from 36 patients with low- and high-grade CIN lesions were studied before and after DLLE treatment looking for HPV sequences. DNA was extracted to perform a radioactive polymerase chain reaction (PCR) using GP 5,6 generic primers. PCR products were analyzed by the single-stranded conformational polymorphism (SSCP) which is a simultaneous detection and typing method. Dot-blot hybridization with generic and type-specific biotinylated oligonucleotide probes was applied in some cases. RESULTS: HPV DNA was found in all pretreatment samples, and the viral type was identified in 80% of them, HPV 16 being the most prevalent. The viral type coincided with that detected in the first biopsy in all except one case. Seventy five percent of the patients (27 cases) were negative for CIN at follow up, but 50% of them remained HPV DNA positive. CONCLUSION: DLLE treatment was effective in removing the CIN lesion but not the HPV. This fact points out the need to asses the presence of HPV in DNA during the follow-up, since viral persistence has been considered a high risk factor for recurrence and/or malignant transformation.

Efficacy of adjuvant chemotherapy for endometrial carcinoma with high-risk factor for recurrence

Between April 1989 and December 1992, 38 patients with endometrial cancer who were at high risk for recurrence entered a prospective study designed to evaluate the efficacy of adjuvant platinum (cisplatin), adriamycin (doxorubicin), and cytoxan (cyclophosphamide) (PAC) chemotherapy. Patients received cisplatin (50 mg/m(2)) doxorubicin (30 mg/m(2)) and cyclophosphamide (500 mg/m(2)) at 3-week intervals for 2-3 cycles. All patients completed the treatment, there were no life-threatening adverse events. The median duration of follow-up was 52.9+/-16.9 months. Six patients developed a recurrence, and 4 of them died after a median interval of 45.5 months. Five of the six patients with recurrence had stage IIIc disease. The 3-year progression-free survival was 83.3%, the overall survival rate was 89.2%. Results suggest that adjuvant chemotherapy with PAC may reduce the incidence of recurrence and improve the survival rate of patients with endometrial cancer.

The recurrence risk of the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) in subsequent gestations

Objective: Although it is an important clinical issue, accurate prediction of recurrence risk for the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP) has been problematic because of limited patient experience. This study was undertaken to determine the likelihood that this form of severe preeclarnpsia-eclampsia or any other hypertensive disorder would occur in a subsequent pregnancy.Study Design: An extensive retrospective analysis of medical records and patient follow-up regarding subsequent pregnancy outcome were undertaken for the 481 patients with HELLP syndrome managed at this tertiary medical center between Jan. 1, 1980, and Oct. 30, 1991. The Mississippi three-class system was used to define severity of disease on the basis of the lowest observed perinatal platelet count (class 1 ≤ 50,000/μl, class 2>50,000/μl to ≤ 100,000//μl, and class 3>100,000//μl to ≤ 150,000/μl).Results: Subsequent gestations (n = 195) occurred in 122 of 481 patients. Evaluable data were available for analysis in 161 of 195 possible pregnancies. Seventy-eight (48%) pregnancies were complicated by some type of hypertensive disorder, 44 (27%) of which had class 1, 2, or 3 HELLP syndrome. Non-HELLP preeclampsia-eclampsia was detected in 25 subsequent gestations (15%). Thus the total frequency of preeclampsia was 69 in 161 (43%). If the data for class 3 HELLP are completely excluded from the analysis, 81 subsequent evaluable and viable gestations were identified, 19 pregnancies with preeclampsia-eclampsia (23%) and 15 patients with HELLP syndrome (19%), for a total recurrence rate of 42%. Subsequent HELLP gestations were frequently delivered abdominally (64%) on average 2 weeks later than the index pregnancy (32.6 ± 5.0 weeks versus 34.7 ± 5.3 weeks). Delivery at < 32 weeks conferred a high risk (61 %) for a similar preterm delivery in a subsequent gestation.Conclusion: The risk of recurrence of the HELLP syndrome in our population is 19% to 27%. When data from all pregnancies with all farms of preeclarnpsia are considered, the risk of recurrence for any type of preeclampsia-eclampsia is 42% to 43%. A previous preterm delivery is a very high risk factor for recurrence of prematurity with preeclampsia-eclampsia.