Micheline Byrne

The effect of interferon on human papillomaviruses associated with cervical intraepithelial neoplasia

Summary. A double‐blind, placebo‐controlled, trial of leucocyte interferon showed that, contrary to previous reports, interferon had no significant effect on cervical intraepithelial neoplasia (CIN) when applied topically in a geld. DNA hybridization of cervical scrapes was used to monitor the effect of interferon on the human papillomaviruses (HPV) associated with CIN. There was, however, no significant difference in the expression of HPV 6 or 16 in the cervical epithelium of patients treated with interferon compared with those given a placebo. By using superficial cells scraped from the surface of the cervical epithelium as a source of DNA for viral studies, we were able to investigate the relation between HPV and CIN without interfering withthe natural history of the disease. HPV 16 was detected in lesions which persisted while HPV 6 only was detected in one lesion that regressed. Regression was clearly associated with reduction in the number of copies of viral DNA per cell in this case. Dual infection with HPV types 6 and 16 were recorded in two patients with persistent lesions. In one patient, hybridization studies indicated that infectionwith HPV 16 could have occurred after infection with type 6 was established, and it is postulated that this may have changed the nature of the cervical lesion.

Topical anaesthesia with lidocaineprilocaine cream for vulval biopsy

tic advantage from curettage in women below 35 years of agc. We conclude that dilatation and curettage has an important role in the diagnosis of endometrial pathology in women aged 40 or more particularly if the presentation is with irregular vaginal bleeding. In women with menstrual disorders under the age of 40, we agree with previous recommcndations (Grimcs 1982) that dilatation and curettage is riot necessary as an initial procedure as pathology is so uncommon.

Clinical features and outcome of first presentation anogenital warts in men and women

Objective Correlation of clinical features of patients on initial presentation of anogenital warts to outcome of treatment.

Risk factors of female HIV-seropositive patients attending the clinic for sexually transmitted diseases at St Mary's Hospital, London.

Of 3450 women tested for antibodies to human immunodeficiency virus HIV-1 and HIV-2 between September 1985 and July 1989, 61 were positive (1.8%). Twenty-seven of these (44%) were presumed to have acquired their HIV infection by heterosexual contact and 23 (38%) were intravenous drug addicts. In geographical origin, 23 (38%) of the patients were from the UK and 19 (31%) from Africa. Amongst these 61 women, 2 (3%) have since died, one committed suicide and one was suspected of committing suicide.

Screening for Cervical Abnormalities in Women with Anogenital Warts in an STD Clinic: An Inappropriate Use of Colposcopy

An audit of the use of colposcopy in women with anogenital warts was performed. Fifty women attending a clinic for sexually transmitted diseases in a District General Hospital with anogenital warts were examined by cervical cytology and colposcopy for cervical infection by human papillomavirus (HPV) or epithelial abnormality indicating cervical intraepithelial neoplasia (CIN) or both. Collated results showed a high prevalence of both conditions in these 50 women; 20 (40%) had evidence of cervical infection by HPV and 11 (22%) epithelial abnormalities consistent with CIN 1 or 2. However, neither CIN 3 nor invasive disease was detected. Colposcopy in this setting was shown to be a specific but insensitive tool and its role in the routine management of women with anogenital warts at our institution is not warranted.

Women with cervical cytological atypia and genital tract infection: Implications and management

SummaryNinety-three women with atypical cervical smears attending the sexually transmitted diseases clinic were further investigated using various microbiological methods, cytology and colposcopy. The smear was defined as atypical when it was reported to show nuclear atypia of the epithelial cells not sufficiently pronounced to be termed dyskaryotic or cellular changes suggestive of human papillomavirus (HPV) infection. In addition, many of the smears contained numerous polymorphonuclear leucocytes. Microbiological studies revealed that 37 per cent of the patients were infected with microorganisms other than HPV. Chlamydia trachomatis was the pathogen most commonly detected, being present in 16 per cent of them. The repeat smear remained atypical in 45 per cent of the women and was more likely to remain so if there were cellular changes consistent with HPV infection. In contrast, persistent atypia were not influenced by the occurrence of the infections other than with HPV. Cervical intra-epithelial neopla...

Cervical cancer associated with mild dyskaryosis

prospective trial comparing continuous arteriovenous ultrafiltration and haemodialysis with conventional daily intermittent bicarbonate haemodialysis in ventilated patients with acute renal failure. All patients are fed 18-26 g of nitrogen daily. So far we have studied 61 patients. The mortality is 77% (24/3 1) in the conventional group and 57% (17/30) in those undergoing continuous arteriovenous ultrafiltration and haemodialysis. This difference is not yet statistically significant, but our experiences encourage us to continue. Secondly, we advocate the use of a haemodialysis machine to control the procedure. The initial outlay is expensive (£900041 000), but the advantages ofsafety and simplicity are valuable. We have used a Fresenius 2008C machine and F40 hollow fibre polysulphone dialysers with a Scribner shunt. In theory any machine that has volumetrically controlled ultrafiltration and bicarbonate dialysis would be suitable to use with a high flux biocompatible membrane. Finally, we are concerned that the authors advocate the use of this potentially dangerous technique in intensive care units that are not experienced with the concepts and intricacies of haemodialysis. Continuous arteriovenous haemodialysis has enabled very ill patients who might otherwise require immediate transfer to a specialised centre to be managed in their base hospital. But ifthese patients are ill enough to require continuous arteriovenous haemodialysis we think that they ought to be moved to a specialist intensive care unit as soon as possible.

Chronic giant ulceration of the vulva in an HIV seropositive woman

Herpes simplex virus (HSV) infection is a common cause of genital ulceration. Primary presentation is usually with multiple, small, discrete, tender ulcers. We report an unusual case of chronic, giant ulceration of the vulva in a woman immunosuppressed by the human immunodeficiency virus (HIV). This was the first presentation of symptomatic disease. The diagnosis of HSV infection was made initially on histological examination of a punch biopsy from the ulcer and subsequently confirmed by viral isolation. The response to antiviral therapy with acyclovir was rapid. Other causes of genital ulceration are discussed and we highlight the diagnostic benefit of histological examination of a punch biopsy.