Achim Schneider

HUMAN PAPILLOMAVIRUS INFECTIONS IN WOMEN WITH AND WITHOUT ABNORMAL CERVICAL CYTOLOGY

9295 smears, obtained from women attending three gynaecological hospitals for routine screening, were examined for human papillomavirus (HPV) types 6 and 11 and HPV 16 and 18 infections by filter in-situ hybridisation. The data were compared with cytological findings. In women with normal cytological smears HPV infection was identified in about 10% of women aged between 15 and 50 years and in less than 5% of those aged over 50. In women with abnormal smears (cervical intraepithelial neoplasia [CIN] I, II, and III and invasive cancer) HPV infection was detected in 35-40%; this rate seemed to be age-independent. the Peak incidence of CIN appeared several years after that of HPV infection. In women aged greater than 30 years it also declined earlier than did HPV positivity. The age-group distribution of women with CIN I, II, and III differed significantly from that of patients with invasive cancer. Only about a third of HPV-positive patients remained virus-positive, probably because of fluctuations in virus production and the insensitivity of the test system used. It is possible that filter in-situ hybridisation underestimates the total rate of HPV infections by a factor of 2 to 3.

Analysis of benign and malignant urogenital tumors for human papillomavirus infection by labelling cellular DNA

A total of 268 biopsies from the genital region was screened for the presence of human papillomavirus DNA. The specimens included carcinoma of the vulva, vagina, cervix, corpus uteri, ovaries and penis, and Bowens carcinomas, Bowenoid papuloses, Bowens disease, cervical intraepithelial neoplasias (CIN I to III), Buschke-Löwenstein tumors, a cervical polyp, decidua, endometrium and histologically normal biopsies. Of 45 carcinomas, 18 contained either HPV 16 and/or 18 and 3 HPV 6-related sequences.In a few individual biopsies double or even triple infections were noted. Unusual was the presence of HPV 2-related DNA in one biopsy from Bowens disease, whereas 2 condylomata acuminata contained HPV 3-related DNA and one contained HPV DNA related to a group of epidermal HPVs found in epidermodysplasia verruciformis lesions.

Human papillomavirus DNA in women without and with cytological abnormalities: results of a 5-year follow-up study.

To determine the prevalence of HPV 6, 11, 16, and 18 in a population without cytological or histological abnormalities, the cervical smears of women attending three clinics in Germany were screened over the past 5 years. The filter in situ hybridization method was used throughout. A total of 20,161 smears, taken from 11,667 women, were tested. When the results of only the first examination are considered, 8.8% (950/10,778) of women with normal cytology were positive for HPV DNA. If we divide the latter into age groups, 11% (852 HPV positive/7716) were below the age of 55 years and 3.2% (98 HPV positive/3062) were above this age. When the samples from patients who had undergone at least two examinations and remained cytologically negative during the 5-year period were examined (total, 2709 women), the HPV DNA positively increased to 34.7% (640/1862) for the sexually active age groups and to 9.0% (76/847) for those above 55 years of age. This study reveals that, although papillomaviral production is most pronounced in younger women, these infections are quite common in all age groups. During the period of investigation, 19 (0.65%) patients, who were diagnosed as cytologically negative at the first examination, progressed to carcinoma in situ or invasive carcinoma. Of these, 63.2% revealed a detectable HPV infection during the study period. The progression of HPV-positive women from normal cytology to CIN or cancer occurred at an annual frequency of 0.082%. With an infected lifespan of 45 years assumed, this results in a lifetime risk of 3.7%.

Subclinical Human Papillomavirus Infections in Male Sexual Partners of Female Carriers

The male sexual partners of 156 women with human papillomavirus infection of the cervix uteri were examined. In 120 men (77 per cent) penile lesions were found on examination of the penis via a colposcope (peniscopy) the most common of which were flat acetowhite lesions (53 per cent). Predilection sites of lesions were the urethral meatus and the corona glandis (23 and 19 per cent of the lesions, respectively). Using filter in situ hybridization human papillomavirus-deoxyribonucleic acid was found in penile smears of 61 men (39 per cent). The cancer-associated viral types (human papillomavirus 16 and 18) were identified in 75 per cent of the human papillomavirus positive men. Viral types of sexual partners were identical in 87 per cent. The correlation between infections with human papillomavirus 16 and 18, and the severity of the cervical lesion was significant in corresponding sexual partners. Our results support the hypothesis that male sexual partners represent a risk factor by acting as a reservoir for genital infections with papillomaviruses. The majority of human papillomavirus infections are of subclinical character. They require sensitive diagnostic techniques, such as peniscopy and hybridization for their identification. Detection and treatment of subclinical human papillomavirus infection in men may be important for the prevention of genital cancer in women.

Pork intake and human papillomavirus-related disease.

Clinical and ecological evidence supporting an association between human papillomavirus (HPV)-related tumors and dietary factors are presented. Abstinence from high intake of fried pork (600-1,000 g/day) was associated with regression of an urethral condyloma in a healthy 19-year-old man treated with interferon gamma. International correlations suggest that pork intake is positively associated with incidence of cervical cancer, a disease also related to HPV. Pork meat or dietary factors associated with pork meat consumption may be involved in the development of HPV-related diseases.

Online or face-to-face instruction? A qualitative study on the electrocardiogram course at the University of Ulm to examine why students choose a particular format

BackgroundSince the introduction of the e-learning electrocardiogram (ECG) course ‘ECG Online’ into the curriculum at the University of Ulm, a small but relatively constant number of students have decided not to participate in the online course but to attend the face-to-face course, although the content of both courses is identical. The present study examined why students prefer one format or the other.MethodsIn a qualitative research approach, ten medical students were questioned in a guided interview. At the time of the survey the interviewees were enrolled in the 7th to 10th semesters. Among the respondents, 2 had participated only in the face-to-face ECG course, 4 only in the online version and 4 in both the face-to-face and the online course.ResultsInterestingly, the very factors associated with e-learning – and always praised as advantages of it – are viewed critically by the students. Thus, although the 24-h access to learning content was consistently evaluated positively, the unlimited availability (lack of expiry date) was not seen as conducive to learning. The lack of fixed time constraints and the attendant lack of pressure were important reasons why some of the students had discontinued the online course prematurely. A similar distinction was seen in the flexibility of location for e-learning, because the very obligation to be physically present on a particular day at a fixed time led to a higher degree of commitment to courses and a willingness to actually attend the course until the end. In addition, if the content has a high degree of perceived professional relevance face-to-face courses are preferred because they offer the possibility of direct interaction.ConclusionsEven though the small sample size limits the generalisability of the results, our findings indicate that when developing online courses students’ needs could be better met if measures were included to strengthen extrinsic and intrinsic motivation and formats were favoured that enable students to have a minimum level of personal interaction with the lecturer.

Conventional Cytology is Insensitive for the Detection of Genital HPV Infection

Cytological examination and colposcopy are indispensable techniques for the diagnosis of cervical intraepithelial neoplasia. Cytological examination is regarded as a superior screening method, whereas with colposcopy lesions can be localized and graded accurately [1, 2]. Recent studies show that cervical infection with human papillomavirus (HPV) precedes development of cervical intraepithelial neoplasia [3-5]. Thus, prevention of the latter should focus on the detection and treatment of cervical HPV infection not yet associated with intraepithelial neoplasia. Highly sensitive molecular biological techniques show a surprisingly high prevalence rate of HPV infection of between 10% and 38% in asymptomatic women [6–11]. The cytological smear shows “classic” signs of HPV infection — koilocytosis and dyskeratocytosis — in only l%–2% [12, 13]. In order to improve the sensitivity of cytological examination we tested a panel of “nonclassic” signs. In a second study we critically evaluated the sensitivity of conventional cytology and colposcopy for the detection of HPV infection.