Mario Sideri

Operator variability in disease detection and grading by colposcopy in patients with mild dysplastic smears

Background. To determine interoperator variability in the colposcopic evaluation of patients with mild dysplastic smears, retrospective comparison of colposcopy and biopsy results in 856 patients examined by 11 colposcopists in the Outpatient Colposcopy Clinic of “L. Mangiagalli” Institute, Milano, was performed.

Comparison of repeat smear, colposcopy, and colposcopically directed biopsy in the evaluation of the mildly abnormal smear

Repeat smear, colposcopy, and colposcopically directed biopsy were performed in 161 patients referred to our department because of a Pap smear showing mild dysplasia (CIN 1). Colposcopically directed biopsies revealed the presence of CIN of different grades in 61 cases (37.5%). In 33 (20.4%) the CIN grade found at biopsy was higher than 1. Repeat smear confirmed the presence of CIN 1 in 67 women (47.2%). In this group of patients colposcopically directed biopsies showed a CIN grade greater than 1 in 12 cases (17.9%). The repeat smear was negative in 59 patients (41.5%). In this group, biopsy showed varying grades of neoplasia in 12 cases. Colposcopic examination indicated no dysplasia but the presence of minor cervical abnormalities in 76 women (47.2%): at biopsy a CIN grade higher than 1 was found in 9 cases (11.5%). These data suggest that the mildly atypical smear identifies a group of patients at increased risk of CIN but gives little or no information on the disease severity. Repeat smear and colposcopic examination alone appear inadequate to demonstrate the severity of the cervical lesion. Due to the high proportion of CIN 2 and 3 in patients with a mildly abnormal smear, the systematic biopsy of any colposcopically abnormal area seems essential to proper management of the patient.

Risk factors for vulvar lichen sclerosus

To assess risk factors for vulvar lichen sclerosus data were collected in a case-control study of 75 cases and 225 age-matched control subjects. Questions concerned personal characteristics and habits, gynecologic and obstetric data, general indicators of sexual habits, and selected dietary habits. The risk of vulvar lichen sclerosus was greater in parous women than nulliparous women, but there was little tendency for the risk to increase with number of births; the finding was not significant when only married women were considered. There was no material difference between cases and control subjects in relation to major indicators of sexual habits (age at first intercourse and number of sexual partners). A smaller proportion of cases was married, but no difference was observed in the distribution of cases and controls with reference to education, smoking habits, body mass index, and previous history of diabetes. There was no association between retinoids and risk of vulvar lichen sclerosus, but intake of carotenoids was inversely and strongly associated with vulvar lichen sclerosus. This apparent protection did not materially change after adjustment for socioeconomic status and other potential confounding factors.

Determinants of high-grade dysplasia among women with mild dyskaryosis on cervical smear.

Objective To identify the epidemiologic characteristics of women who have mild dyskaryosis on cervical smear but cervical intraepithelial neoplasia (CIN) grade II or III at biopsy. Methods We analyzed information from 291 women (median age 33 years, range 17–69) observed for the first time with a single smear test showing mild dyskaryosis. All subjects underwent colposcopy, and histologic confirmation was obtained by biopsy. We compared the characteristics of women who had CIN I or no evidence of CIN with those of women with CIN II or III at biopsy. Results Twenty-eight women (10%) had CIN I at biopsy, 46 (15%) CIN II, and 23 (8%) CIN III. The frequency of CIN II or III tended to decrease with increasing education; compared with women reporting 11 or fewer years of education, the multivariate odds ratios (OR) of CIN II or III lesions was 0.5(95% confidence interval [CI] 0.3–0.9) in those reporting 11 years of education or more. Compared with nulliparas, the OR of CIN II or III was 1.8 (95% CI 1.1–3.5) for parous women. Furthermore, compared with never-smokers, the OR of CIN II or III was 2.3 (95% CI 1.0–5.4) for current smokers. Ex-smokers were at increased risk, too; the estimated multivariate OR was 3.8 (95% CI 1.9–7.6). Compared with women reporting one sexual partner, the multivariate ORs of CIN II or III were 1.4 and 2.3 for women reporting two to three or four or more sexual partners, respectively (X21 trend = 6.65, P < .05). Conclusion Our results show that smoking is a risk indicator of CIN II or III in women with a single smear showing mild dyskaryosis. Parous women, those of low social standing, and those reporting multiple sexual partners also are at increased risk of CIN II or III.

THE ULTRASTRUCTURAL BASIS OF THE NUTRITIONAL TRANSFER: EVIDENCE OF DIFFERENT PATTERNS IN THE PLASMA MEMBRANES OF THE MULTILAYERED PLACENTAL BARRIER.

Fetal growth and development are promoted by an active nutritional transfer involving a variety of mechanisms (’carriers’,’pumps’, receptors) observed in the placental plasma membranes (Whitsett and Brownscheidle, 1979). From the anatomical point of view, the series of plasma membranes interposed between mother and fetus are formed by 1) the syncytial plasma membrane in contact with the maternal blood (SPM-m), 2) the syncytial plasma membrane in contact with the cytotrophoblast or the trophoblastic basement membrane (SPM-f), 3) the different cytotrophoblastic plasma membranes (CPM), and 4) the endothelial plasma membranes of the fetal capillary.

Immunologically undetectable human placental lactogen in a normal pregnancy.

MARIO SIDERI*, GIUSEPPE DE VIRGILIIS*, FRANCESCA GUIDOBONO

The junctional pattern of the human villous trophoblast: A freeze-fracture study

, NICA BORGESEq, LUCIA PICENI SERENI

Peculiar ruthenium red staining pattern of the human early trophoblast

, UMBERTO NICOLINI* & GIANNI REMOTTI? *First Clinic of Obstetrics and Gynaecology, ?Section of Obstetrical and Gynaecological Pathology,

Junctional Pattern in the Squamous Metaplasia of the Female Trigone. A Freeze-Fracture Study

3rd Chair of Pharmacology, School of Medicine,

Transfer of Horseradish Peroxidase Across the Human Placental Cotyledon Perfused in Vitro

Department of Laboratory Medicine of the Instituti Clinici di Perfezionamento and a CNR Centre of Cytopharmacology, University of Milan, v Commenda, 12-201 22 Milan, Italy