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Biomedical subjects

A Ferenczy

Publications and source records attributed to A Ferenczy.

At least 55 records · Page 3Linked to original sources
PubMed1994

Cervical cytology with the Papette sampler.

The most reliable cervical smears for the detection of cervical cancer and its precursors are those which contain cells from the transformation zone and endocervical canal. To verify that these regions have been sampled, the cytologist must recognize either endocervical cells or immature squamous metaplastic cells on the smears. We performed an open clinical trial with a new device, the Papette, which simultaneously samples both the exocervix and endocervix. The overall cytologic quality of the smears and the device's acceptability to physicians were assessed in 1,000 women seen consecutively. The smears were compared with those collected from 1,000 women immediately after the trial using the Ayre spatula-Zelsmyr Cytobrush technique. Both the Papette and the spatula-Cytobrush obtained satisfactory smears in 91.4% and 96.0% of cases, respectively. Cell transfer onto glass slides was easier and bleeding observed less frequently with the Papette than with the spatula-Cytobrush, but the latter was more suitable for patients with a retroflexed uterus and narrow external os. Overall, the Papette harvested high-quality cellular samples and may be an option for cervical cytology.

Adolescent↗
PubMed1993

Vaginal squamous cell carcinoma with sarcomatoid spindle cell features.

A vaginal squamous cell carcinoma with prominent sarcomatoid spindle cell features found in a 25-year-old female is presented. The exclusively spindle-shaped growth pattern of the neoplastic cells in the initial biopsy led to the diagnostic impression of a sarcoma. This in turn has resulted in an attempt at completely resecting the tumor. The 5.2 x 3.5-cm resected lesion, however, blended peripherally with a poorly differentiated squamous cell carcinoma. Moreover, the sarcomatoid component reacted with vimentin and cytokeratin, and tonofilaments and desmosomes were seen by electron microscopy. This apparently unique case indicates the need for obtaining representative tissue samples for providing an appropriate diagnosis prior to definitive therapy for vaginal squamous cell carcinoma. The primary treatment for large stage I squamous cell lesions of the vagina is radiotherapy, whereas an equally large sarcoma is best treated by wide local excision alone.

Adult↗
PubMed1993

Human papillomavirus testing in the clinical laboratory. Part I: squamous lesions of the cervix.

The aim of this study was twofold: (1) to evaluate the contribution of viral (HPV) testing for improving the sensitivity of cervical cytology and (2) to correlate HPV types with the histology of the detected cervical cancer precursors, particularly the low-grade, CIN I variant. We used the dot blot hybridization technique (ViraPap) and polymerase chain reaction (PCR) in 63 women referred to our colposcopy clinic for evaluation of an abnormal Pap test. Histopathologic samples obtained by multiple colposcope-directed punch biopsies were used for a diagnostic gold standard. Among the 53 women with histologically proven CIN, precolposcopy cytology was positive in 38 (72%) compared to 53% and 60% HPV positivity by ViraPap and PCR, respectively (p less than 0.01). When the yields of ViraPap/PCR and cytology were combined, however, the detection rate of CIN was 91%, a significant improvement over cytology alone (p less than 0.02). HPV DNA was found either by ViraPap or PCR in 45 of 63 (71%) biopsy specimens, and 37 of 38 (97%) HPV-positive CIN, including the low-grade CIN I variant, contained oncogenic HPV types. HPV type 16 was present in 22 of 38 (58%) CIN lesions and mixed with HPV 6/11, 18, or the 30s group in 6 of 38 (16%) of the cases. HPV 6/11 alone was found only in 1 case of CIN I (2.7%). HPV testing by molecular technology increases the sensitivity of cytology.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Human papillomavirus testing in the clinical laboratory. Part II: vaginal, vulvar, perineal, and penile squamous lesions.

The accurate diagnosis of HPV-related diseases of the lower genital tract requires expertise, and sometimes even the expert may face a dilemma as to the precise nature of the biopsies submitted from colposcopically suspicious HPV-related lesions. We have evaluated the role of viral testing using dot blot hybridization (ViraType) and PCR in the diagnosis of histologically typical (42 cases) and equivocal (30 cases) squamous intraepithelial lesions of the vagina (7), vulva (30), perianal epithelium (3), penis (31), and scrotum (1). The viral kits were used according to the manufacturer's instructions in a routine laboratory setting, and the probes available were HPV 6/11, 16, 18, and 31, 33, 35 (the 30s group). HPV DNA was found in 45 of 72 (62%) of all lesions. PCR was more sensitive (58%) than ViraType (39%) for detecting HPV DNA sequences (p less than 0.02), particularly in equivocal lesions (EQHPV), 14 of 30 (47%) by PCR vs 4 of 30 (13%) by ViraType (p less than 0.004). The majority of lesions contained oncogenic type viruses irrespective of their histologic presentation, namely, type 16. Only condylomata acuminata were predominantly HPV 6 or 11 positive. Viral testing may play a role in the quality control of the diagnostic expertise of routine laboratories as well as ascertaining the HPV-relatedness of histologically equivocal lesions of the anogenital tract. In view of the relatively high false-negative rates for detecting HPV DNA by ViraType and PCR, only a positive test may be meaningful unless other HPV types are added.

Carcinoma, Squamous Cell↗
PubMed1993

Management of the patient with an abnormal Papanicolaou test. Recent developments.

Based on available data, virtually all cervical cancers and the majority of their high-grade precursors (Hi-SIL/CIN 2-3) contain sexually transmitted oncogenic HPV types, among these the most common type is HPV type 16. In current practice, the most cost-effective diagnostic and therapeutic means for Hi-SIL/CIN lesions is LEEP. Judgment must be exercised, however, to tailor the depth of electroexcision of cervical cancer precursors, particularly with respect to the low-grade variants, according to the position of their endocervical lesional margin. About half of the low-grade lesions also carry intermediate- to high-risk oncogenic viruses; unfortunately, morphology cannot identify them unless abnormal mitotic figures are present on the histologic sections. When sophisticated, low-cost viral probing tests and perhaps Cervicography become available, it may be pertinent to determine whether a low-grade lesion contains low-risk virus or is associated with a high- to intermediate-risk virus group. Indeed, the former are unlikely to progress to invasion and may, in fact, regress without therapy other than multiple biopsies, whereas the latter carry high-risk carcinoma potential. Treating long-term monogamous men with asymptomatic, subclinical lesions who are partners of HPV-infected women is not considered cost effective, for they do not seem to reinfect each other. Management strategies for patients with HPV infections should not only be therapeutic but also educative, encouraging patients to practice sexual monogamy.

Biopsy↗
PubMed1993

Comparison of transdermal and oral sequential gestagen in combination with transdermal estradiol: effects on bleeding patterns and endometrial histology.

OBJECTIVE: To assess prospectively the effect on bleeding patterns, transformation of the endometrium, and rate of endometrial hyperplasia of transdermal norethisterone acetate when administered sequentially in combination with transdermal estradiol (E2), and to compare it to a regimen using oral medroxyprogesterone acetate. METHODS: Two hundred eighteen women were randomized to receive either transdermal E2 0.05 mg/day for 14 days followed by transdermal E2 0.05 mg/day plus transdermal norethisterone acetate 0.25 mg/day for 14 days, or transdermal E2 0.05 mg/day for 25 days with the addition of oral medroxyprogesterone acetate 10 mg/day on days 16-25, followed by a 3-day treatment-free period. Treatment was planned for 13 cycles of 28 days. The subjects kept daily bleeding diaries, and endometrial biopsies were taken before and at the end of treatment. RESULTS: The mean duration of bleeding (regular) induced by the gestagen was 7.33 days in the transdermal gestagen-treated group, which was 1.54 days longer than in the oral gestagen-treated group (P = .0001). The mean cycle day of onset was 25.74. Bleeding was spotting or light in the transdermal group in 77% of the days in which bleeding occurred. When comparing the two groups, there were no differences in the overall mean cycle day of onset or in the intensity of gestagen-induced bleeding. Breakthrough (irregular) bleeding episodes occurred in 42% of the transdermal subjects, lasted a mean of 4.18 days, and were spotting or light in 87% of the days when they occurred. There were no differences between the treatment groups. There was only one case (1.3%) of confirmed simple hyperplasia and five cases of failure of gestagenic transformation of the endometrium in 77 women treated for a mean of 367 days with transdermal gestagen. CONCLUSION: A transdermal system delivering a combination of E2 and norethisterone acetate for 14 days in sequence with E2 delivered transdermally for 14 days produced bleeding patterns that are clinically acceptable and comparable to those produced by oral medroxyprogesterone acetate given in sequence with E2 delivered transdermally for 25 days. The use of the combination system was not associated with a significant risk of endometrial hyperplasia.

Administration, Cutaneous↗
PubMed1992

Comparison of specimens removed by CO2 laser conization and the loop electrosurgical excision procedure.

A comparison is made of the histologic changes in the cervical epithelium and stroma following CO2 laser conization and office excisional biopsy of cervical tissue using the loop electrosurgical excision procedure. In both types of specimens, two zones of thermal injury were detected. The zone at the margin of resection measured approximately 50 microns in thickness and was characterized by extensive carbonization and charring. The other zone was much more variable in thickness and characterized by tissue coagulation, but lacked charring. No significant difference in the biocharacteristics or extent of thermal damage was detected between the methods. For 11 specimens obtained with the CO2 laser, the coagulated zone ranged from 130-750 microns in greatest thickness; the mean thickness was 411 microns. For 40 specimens obtained using the loop procedure, the range of thickness of the coagulated zone was 150-830 microns, and the mean thickness was 396 microns. The difference in the mean value of thermal injury (measured in microns) between the laser and loop procedures was not significant (Student t test; P = .79). Extensive areas of carbonization and epithelial distortion at the margins of excision were only occasionally present in specimens obtained by the electrosurgical excision procedure but almost invariably present in CO2 laser specimens. However, in all cases it was possible to evaluate the epithelium and the stroma both histologically and cytologically.

Carbon Dioxide↗
PubMed1992

Treatment of cervical intraepithelial neoplasia using the loop electrosurgical excision procedure.

In selected patients with cervical intraepithelial neoplasia (CIN), outpatient ablative procedures represent a readily accepted and highly effective treatment modality. The recently introduced loop electrosurgical excision procedure offers a quick and simple alternative to cryotherapy and laser ablation for treating CIN, and has the distinct advantage of allowing both diagnosis and treatment of selected patients at a single visit. This report presents our clinical experience treating 432 patients with CIN using the loop electrosurgical excision procedure on an outpatient basis. Small loop electrodes were used to excise CIN lesions in 275 patients, and large loop electrodes were used in 157. When performed on an outpatient basis under local anesthesia, loop excision was well tolerated by patients with only minimal discomfort. Post-treatment bleeding occurred in less than 2% of the subjects and responded to either recauterization or packing of the cervix. Post-treatment stenosis occurred in less than 1%. The success rate of the loop electrosurgical excision procedure, as defined by absence of cytologic, histologic, or colposcopic lesions 4-48 months after therapy, was 80% for women treated using the small loop electrodes. Ninety percent of all patients treated using the large loop electrodes were free of disease during 6-12 months of follow-up. For women being treated for primary (as opposed to recurrent) disease, the success rate with large loop electrodes was 94%.

Carcinoma in Situ↗
PubMed1991

Histology of the human endometrium: from birth to senescence.

Embryologically, the human endometrium is of mesodermal origin, and constitutes the mucosal lining of the fused Mullerian ducts of the uterus. In the adult, premenopausal woman, the endometrium follows a precisely programmed series of morphologic and physiologic events, characterized by growth, secretory differentiation, and in the absence of conception, degeneration and regeneration. Proliferation, secretion and degeneration are confined to the upper functionalis layer, whereas the lower basalis layer is the seat of regenerative endometrium. In the postmenopausal years, absence of biologically significant estrogenic stimulation leads to progressive endometrial involution, from proliferative to inactive in the mid-50s to atrophy in the late-60s. Cyclic endometrial alterations are controlled by the ovarian estrogens and progesterone via their respective endometrial intranuclear receptors, and possibly other peptides and enzymes. They provide appropriate environment for the implanting conceptus. The intimate inter-relationship between endometrial structure/function and steroid hormones during the premenopausal period serves as an indicator of the hypothalamo-pituitary-ovarian axis as related to ovulatory states.

Aging↗
PubMed1991

Laser treatment of genital human papillomavirus infections in the male patient.

Thorough examination of the lower anogenital epithelium of promiscuous men and their partners (either male or female) may be useful to diagnose and, if appropriate, treat those who are likely to perpetuate the HPV epidemics and increase the potential risk for cervical carcinogenesis. CO2 laser ablation is a highly attractive means to treat HPV-related disease of the anogenital epithelium in men. The Nd:YAG laser also has some specific applications in the treatment of large, relatively vascular lesions. A stable sexual relationship or consistent use of condoms in polygamous sexual practices is probably the most meaningful means of controlling the sexual transmission of HPV.

Condylomata Acuminata↗
PubMed1991

Pearly penile papules: absence of human papillomavirus DNA by the polymerase chain reaction.

Pearly penile papules clinically resemble the sexually transmitted papular variant of genital condylomata. Histologically, however, pearly penile papules consist of fibropapillomata that lack the characteristic morphologic features of human papillomavirus (HPV) infection. To study the possible association of HPV infections with pearly penile papules, we examined tissue specimens from 13 men with pearly penile papules with and without associated penile condylomata. Biopsy specimens were tested for the presence of HPV DNA by the polymerase chain reaction. None of the pearly penile papules contained HPV DNA sequences, whereas four of seven cases clinically suspected of being condylomata associated with pearly penile papules contained HPV DNA. These results confirm that pearly penile papule lesions do not contain HPV DNA; therefore, the distinction between pearly penile papules and penile condylomata is clinically significant.

Adult↗
PubMed1990

Carbon dioxide laser energy disperses human papillomavirus deoxyribonucleic acid onto treatment fields.

The possibility of dispersing viral deoxyribonucleic acid during carbon dioxide laser treatment of human papillomavirus-containing genital infections has been investigated with a commercially available dot blot hybridization technique. The viral ribonucleic acid probes were specific for groups of human papillomavirus types 6/11, 16/18, and 31/33/35. Laser energy was delivered by continuous-wave mode and the plume of smoke was evacuated by a vacuum suction system. Samples were taken with Dacron swabs from lesional tissues of 43 patients as well as from the treated areas and from the 5 cm surrounding normal skin before and after laser vaporization. Human papillomavirus deoxyribonucleic acid was identified in swabs from 34 of 43 (79%) lesional tissues and 7 of 43 (16%) treatment fields. Although a trend for higher human papillomavirus deoxyribonucleic acid positivity in laser margins after therapy (7/43, 16%) than before (4/43, 9%) was observed, the rates were not statistically significant. It is concluded that carbon dioxide laser energy disperses human papillomavirus deoxyribonucleic acid onto treatment fields and the adjacent normal epithelium. Viral contamination of treated areas may be reduced by positioning the fume evacuator within 1 cm of the field of laser vaporization and cleaning the treated areas and surrounding tissue after therapy.

Adolescent↗
PubMed1990

Underwear: contamination by human papillomaviruses.

Genital human papillomavirus-related lesions occurring in 74 patients and cellular swab samples taken from their underwear were analyzed with a filter hybridization technique (ViraPap-ViraType, Life Technologies Inc., Gaithersburg, Md.) for human papillomavirus deoxyribonucleic acid. Human papillomavirus deoxyribonucleic acid was found in 54 of 74 (72%) lesional tissues and 13 of 74 (17%) swabs from the underwear. Recurrence rates in patients with and without positive underwear swabs were 61% and 29% (p less than 0.05), respectively.

Adult↗
PubMed1990

Human papillomavirus DNA in CO2 laser-generated plume of smoke and its consequences to the surgeon.

Carbon dioxide laser energy is absorbed by intracellular water but not by proteins or nucleic acids. The possibility of dispersing viral DNA during laser therapy of human papillomavirus (HPV)-containing genital infections was explored using a filter hybridization technique. Samples were taken using dacron swabs from 110 patients in nine separate treatment sessions as well as from five pre-filter canisters, four fume vacuum tubes, and from the nasopharynx, eyelids, and ears of the laser surgeon before and after laser surgery. The viral RNA probes were specific for groups of HPV types 6/11, 16/18, and 31/33/35. Human papillomavirus DNA was identified in swabs from 65 of 110 (60%) of histologically unequivocal condylomata and cervical intraepithelial neoplasias. One of the five pre-filter canisters (20%) tested was HPV DNA-positive after laser treatment of 65 patients; it contained HPV DNA type 6. The four fume vacuum tubes tested in the remaining 45 patients were HPV DNA-negative, as were the nasopharynx, eyelids, and ears of the operator. Although HPV DNA may be released during laser vaporization of genital HPV infections, contamination of the operator is unlikely provided appropriate equipment for evacuating HPV DNA-positive smoke is used.

Adolescent↗
PubMed1990

Micropapillomatosis labialis appears unrelated to human papillomavirus.

To clarify the hypothetical etiologic role of human papillomavirus (HPV) for micropapillomatosis labialis, the frequency of HPV infection was compared by dot blot hybridization techniques between vulvar samples from 34 women with micropapillomatosis labialis and 34 women with normal vulvar skin. Although more patients with micropapillomatosis labialis than controls had HPV DNA detected, this was not statistically significant (eight of 34 versus three of 34, respectively; and two of 23 versus one of 34, respectively, when only biopsies were analyzed). In a second part of the study, 22 patients with micropapillomatosis labialis were followed without treatment; the lesion regressed in 45% and persisted in 55% of the patients. Among 11 patients treated with CO2 laser, 5-fluorouracil, or trichloroacetic acid, the lesion persisted in three cases. These results suggest that these introital changes are unrelated to HPV and that a high percentage will regress without treatment.

Adolescent↗
PubMed1990

Perineal endometriosis. A case report.

Perineal endometriosis was found unexpectedly in a 32-year-old woman with primary infertility. Since there had been no prior perineal trauma, the transport of endometrium through a venous or lymphatic route could have accounted for the location of the endometriosis.

Adult↗