Cytology at the time of cervical colposcopy

OBJECTIVE

The efforts of the authors are to evaluate the role of performing a Papanicolaou (Pap) smear at the time of colposcopy.

MATERIALS AND METHODS

This retrospective chart review included patients from 2004 to 2009 who underwent cold knife cone (CKC) biopsy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia types 2 and 3 (CIN 2 and 3) or patients with discrepancy between Pap and colposcopic results. All patients presented to the gynecology clinics in a tertiary care hospital. Results were compared which included: the abnormal Pap smear which led to referral for colposcopy, the Pap smear performed at the time of colposcopy, the colposcopic biopsy, and the excisional biopsy. Interpretation of results was calculated with Cohen's K Statistics.

RESULTS

One hundred forty-seven patients qualified for the study. One hundred five patients had excisional biopsy proven high-grade squamous intraepithelial lesion (HSIL). Eighty-two of these high-grade excisional pathology results were preceded by high-grade Pap cytology at the time of colposcopy; however 23 Pap cytology results indicated either low-grade squamous intraepithelial lesion (LSIL) or negative (20 and 3 respectively), but were followed by an excisional procedure revealing high-grade pathology. Eighty-one colposcopic biopsies confirmed high-grade excisional biopsy pathology. However, 24 colposcopic biopsies were low-grade or negative (13 and 11 respectively), but followed by a high-grade excisional biopsy.

CONCLUSION

The addition of a Pap smear at the time of colposcopy has the potential role of recognizing high-grade cervical dysplasia.

Preimplantation genetic diagnosis: a systematic review of litigation in the face of new technology

OBJECTIVE

To study legal cases against IVF facilities pertaining to preimplantation genetic diagnosis (PGD) misdiagnosis.

DESIGN

Systematic case law review.

SETTING

University medical center using US legal databases.

PATIENT(S)

The IVF recipients using PGD services.

INTERVENTION(S)

Lawsuits pertaining to PGD against IVF facilities.

MAIN OUTCOME MEASURE(S)

Lawsuits, court rulings, damage awards, and settlements pertaining to PGD after the birth of a child with a genetic defect.

RESULT(S)

Causes of action pertaining to PGD arise from negligence in performing the procedure as well as failure to properly inform patients of key information, such as inherent errors associated with the PGD process, a facility's minimal experience in performing PGD, and the option of obtaining PGD. Courts have sympathized with the financial burden involved in caring for children with disabilities. Monetary damage awards are based on the costs of caring for children with debilitating defects, including lifetime medical and custodial care.

CONCLUSION(S)

Facilities offering PGD services expose themselves to a new realm of liability in which damage awards can easily exceed the limits of a facility's insurance policy. Competent laboratory personnel and proper informed consent--with particular care to inform patients of the inherent inaccuracies of PGD--are crucial in helping deter liability.

Monoclonal antibodies to an HIV-1 group O envelope recombinant

Monoclonal antibodies were developed to a recombinant HIV-I group O envelope protein derived from the isolate HAM112. These monoclonal antibodies were characterized for reactivity to a series of overlapping synthetic peptides (29-30 mers) covering gp120 C-terminal and gp41 ectodomain regions of the HIV-1 group O envelope protein. Most of these monoclonal antibodies reacted with peptides spanning sequences analogous to HIV-1 group M epitopes identified from studies in mice and humans. However, several of the antibodies that were nonreactive to individual peptides did react to a mixture of longer peptides from the N-terminal and C-terminal helical regions of the gp41 ectodomain. The monoclonal antibodies described in this study are valuable tools for characterization of antigenic differences between HIV-1 group O and group M viruses.

Quantitative immunolocalization of a P29 protein (GRA7), a new antigen of toxoplasma gondii

Ultrastructural localization of a P29 protein of Toxoplasma gondii was examined on thin sections by an immunogold technique using a P29 antigen-specific monoclonal antibody (5-241-178). Immunolocalization of the P29 protein in extracellular tachyzoites demonstrated that this antigen was present in the dense granules. Thus, we have identified this P29 antigen as the seventh protein (GRA7) to be localized to the dense granules of T. gondii. P29 immunolocalization in intracellular tachyzoites demonstrated association of this antigen with the parasite membrane complex, tubular elements of the intravacuolar network, and with the parasitophorous vacuolar membrane. Our immunolabeling data suggest trafficking of the P29 (GRA7) antigen from the dense granule via the intravacuolar network to the parasitophorous vacuolar membrane on invasion of the tachyzoite into the host cell. (J Histochem Cytochem 46:1411-1421, 1998)

Cardiovascular responses to norepinephrine and arginine vasopressin infusion in chronically catheterized fetal lambs

Fetal cardiovascular responses to infused norepinephrine (NE) and arginine vasopressin (AVP) were compared in bilaterally vagotomized and chronically catheterized (control) fetal lambs. In the control fetuses, NE infusion was characterized during the first five minutes by a decreased fetal heart rate (FHR) and increased mean arterial blood pressure (MABP) and by a preejection period (PEP) followed by a gradual return to the original values. NE infusion in vagotomized fetuses was followed by tachycardia, decreased PEP without the initial prolongation and an MABP response similar to that in the controls. AVP in control fetuses caused a persistent decrease in the FHR and increase in MABP and PEP. Vagotomy affected only the FHR response: the decrease was persistent but smaller. AVP produced persistent fetal cardiovascular responses regardless of vagotomy; however, the biphasic response FHR pattern, suggestive of NE tachyphylaxis, was eliminated by vagotomy.

Discrimination of hepatitis B virus (HBV) subtypes using monoclonal antibodies to the PreS1 and PreS2 domains of the viral envelope

We report the production and characterization of murine anti-PreS2 and anti-PreS1 monoclonal antibodies (mAb) and demonstrate their utility in discriminating hepatitis B virus (HBV) subtypes. On the basis of Western blotting and reciprocal competition binding to HBV virions, at least five distinct epitopes have been identified in the PreS domain: two within the PreS1 region and three within the PreS2 region. All PreS2 mAb bind M protein (gp33 and gp36) but only one group binds strongly to M and L proteins (p39 and gp42). This group determinant was mapped to peptide residues 120-145. The second group bound to an endoglycosidase F-sensitive epitope which is defined by a mannose-rich glycan at ASN 123 in the PreS2 region. The third group was mapped to peptide residues 150-174 and was reactive with the M envelope proteins but not L or S proteins on Western blots. All PreS1 mAb bind L protein but not M protein on Western blots. Using these mAb, HBV subtype assays were developed allowing evaluation of the Paris (1975) HBsAg subtype panel members along with other HBsAg-positive specimens. All Paris subtype members (except ayw2 and ayw3) could be easily distinguished by differential PreS2 mAb reactivity. The Paris subtypes, adw2, adw4, and adr, could be classified as distinct groups by PreS2 and PreS1 mAb binding. Specimens from Hong Kong and the United States classified as adw2 in the S region fell into two groups based on PreS2 mAb binding: one having reactivity similar to Paris adw2 subtype and the other having identical reactivity to Paris ayw1 subtype. Furthermore, some specimens classified as adr in the S region gave similar reactivity to the Paris ayr subtype in the PreS2 and PreS1 regions. One complicating factor in this approach toward subtyping was the discovery that some HBsAg positive sera may contain factors which block PreS epitopes. Grouping of HBV subtypes by PreS1, PreS2, and S mAb reactivity may allow better correlation with groupings based on HBV DNA sequence homology.

Effects of norepinephrine on lung fluid flow rate in the chronically catheterized fetal lamb

The influence of norepinephrine on lung fluid flow rate was studied in seven chronically catheterized fetal lambs. Lung fluid was collected through a catheter inserted into the fetal trachea. In six experiments, continuous saline solution infusion for 1 hour followed by equivolumnar norepinephrine (3.0 micrograms/min) for 1 hour via the fetal jugular vein was carried out. In three additional experiments (two fetuses), a 3.0 mg intravenous bolus of propranolol was administered before norepinephrine infusion. Saline solution infusion did not influence the lung fluid flow rate or fetal biophysical and biochemical parameters. Norepinephrine increased fetal blood pressure by 22% and decreased lung fluid flow by 45% from control values. Lung fluid flow rate recovered within 2 hours after the end of the norepinephrine infusion. Pretreatment with propranolol did not alter the results. In addition to previous reports that demonstrated beta-sympathomimetic agonist-enhanced reabsorption of lung fluid from fetal alveolar epithelial cells, our present results suggest that a reduction in fetal lung fluid secretion may be implemented as well through stimulation of alpha-sympathomimetic receptor sites in the pulmonary vasculature.

Action of histamine and its receptor blockers on uterine circulation in sheep

Effects of iv and ia administration of histamine and its H1 and H2 blockers (diphenhydramine and metiamide) on systemic arterial pressure, heart rate, and uterine and iliac blood flows were investigated in unanesthetized, chronically instrumented nonpregnant ewes. Intravenous histamine produced tachycardia, hypotension, and decreased iliac and uterine blood flows. In contrast, ia injections produced a significant increase in blood flows in these vascular beds which was dose-dependent. Evidence is presented to show that some of the circulatory actions of histamine may be related to stimulation of H1 while others may be related to H2 receptors. The peripheral circulatory action produced by iv histamine is probably secondary to its effects on reducing cardiac output. The uterine and iliac vascular beds contain mostly H1 receptors since their response to histamine can be blocked almost totally by Benadryl and not by H2 antagonist metiamide.