Tony Jose

HPV vaccine: Current status and future directions.

HPV Vaccine was introduced to prevent cervical cancer known to be caused by infection with one or more of the high risk subtypes of the Human papilloma virus (HPV). Since introduction, trials have proven its efficacy in preventing Cervical intraepithelial neoplasia (CIN) beyond doubt and its effectiveness in preventing cervical cancer though presumptive is reasonably certain as per mathematical modelling. It also prevents other HPV related anogenital and oropharyngeal malignancies in both sexes. HPV vaccines have courted many controversies related to its efficacy, safety, ideal age of vaccination, use in HPV infected individuals and use in males. The currently available vaccines are based on L1 Viral like particles (VLP) and hence highly species specific, thermolabile, costly and are purely prophylactic. The quest for a cheaper, thermostable and broad spectrum vaccine has led to many newer prophylactic vaccines. Therapeutic vaccines were born out of the inescapable necessity considering high HPV related morbidity projected in the non HPV naïve population. Therapeutic vaccines would immediately reduce this burden and also help in the management of HPV related cancers alone or as part of combination strategies. Ongoing research is aimed at a total control over HPV related malignancies in the near future.

Hydramnios Associated with Foetal Duodenal Atresia.

Hydramnios, an excessive accumulation of amniotic fluid within the amniotic cavity, is not associated with an identifiable cause in the majority of the cases. However, in about one third of the cases an underlying cause is present. Hydramnios may be a manifestation of underlying foetal anomaly in 13%, maternal disorder such as diabetes mellitus in 14% [1] and rarely Rh isoimmunization in less than 1% [2] of cases. A case of severe hydramnios associated with foetal duodenal atresia is presented.

Pediatric ovarian torsion: a diagnostic challenge

http://dx.doi.org/10.1590/0100-3984.2016.0216 Sergio Eiji Ono1, Débora Brighente Bertholdo1, Gustavo Rengel dos Santos2, Arnolfo de Carvalho Neto2 1. Clínica Diagnóstico Avançado por Imagem – DAPI, Curitiba, PR, Brazil. 2. Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil. Mailing address: Dr. Sergio Eiji Ono. Clínica Diagnóstico Avançado por Imagem – DAPI. Rua Brigadeiro Franco, 122, Mercês. Curitiba, PR, Brazil, 80430-210. E-mail: ono.sergio@gmail.com. preservation of vertical gaze, preservation of convergence, and progressive scoliosis, that develops in pediatric patients. The progressive scoliosis is probably secondary to neurological deficits that impair proprioceptive inputs. Our patient had FCD, which is a major cause of epilepsy in children and adults. FCD type II, also known as FCD with the transmantle sign or Taylor-type dysplasia, is classified as a category I malformation of cortical development (MCD), because it involves abnormal neuronal proliferation. The other MCD categories include abnormalities in neuronal migration (category II—e.g., periventricular nodular heterotopia) and abnormal late migration/cortical organization (category III—e.g., FCD type I and polymicrogyria). In a study of 220 patients with MCD and epilepsy, Kuchukhidze et al. analyzed the combination of MBHB malformations and FCD. The authors identified MBHB malformations in 17% of the patients and found that the malformations were more commonly linked to late migration/cortical organization disorders; only one patient was found to have FCD type II. The cases of MBHB malformations were associated with more extensive MCD lesions, as well as with a poor clinical profile (earlier age at seizure onset, neurologic deficits, learning disability, and developmental delay), although no differences were found in the response to antiepileptic treatment. Nearly 25% of the patients with MBHB malformations had FCD type I, which was not detected in MRI studies and was identified only through pathologic examination of a surgical specimen. Studies of MBHB malformations have improved with advances in neuroimaging, molecular biology, and molecular genetics, thus increasing understanding of developmental disorders related to such malformations. Functional MRI techniques can also contribute to a better description and understanding of these diseases.

Non-descent vaginal hysterectomy in women with previous caesarean section scar: our experience

Hysterectomy is the surgical removal of the uterus, being the commonest major gynecological surgeries done worldwide. Conventionally and historically vaginal hysterectomy is done in cases of utero vaginal prolapse and abdominal route used to be performed in most of other indications. Subsequently, hysterectomy through vaginal route for nonprolapse uterus popularly known as, “Non Descent Vaginal Hysterectomy” (NDVH) has proved to be feasible, safe, cost effective and justifiable option in comparison to abdominal route even in large size uterus by various studies.

Occult parametrial metastasis in operable cancer cervix: is a routine radical hysterectomy justified?

Early stages of Ca cervix (Stages IA to stage IIA1) are considered operable and is treated by Type III Radical Hysterectomy (RH) with bilateral pelvic lymphadenectomy especially in younger patients and is designed to surgically cure the disease. Radical hysterectomy typically involves the parametrial resection (PR) requiring extensive ureteric dissection resulting in hemorrhage and injuries to ureter and bladder leading to urinary fistulae. Pelvic autonomic nerves also get transected during PR leading to a host of physiological dysfunctions and morbidity (urogenital, rectal and sexual dysfunction). This is considered necessary because parametrium remains one of the common sites of spread, and parametrial metastasis (PM) is considered to be a high-risk prognostic factor in Ca cervix. Rates of PM varies from 6-13% in various studies and depends on many factors like tumor size, LVSI, Depth of stromal invasion (DOSI), and Pelvic LN metastasis (PLM). Though cases with obvious PM undergo primary radiotherapy (RT), being a clinically staged disease, ABSTRACT