Human papillomavirus and cancer of the uterine cervix.
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Biomedical subjects
Publications and source records attributed to A Meisels.
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In our clinic, as a rule, we do not treat vaginal condylomata. They are usually subclinical and asymptomatic. When atypia is present on biopsy, they should be treated in the same manner as vaginal intraepithelial neoplasia. When vaginal discharge and pruritus are present, infection should be searched for and treated. When condylomata are seen with the naked eye, colposcopy has shown that there were many more, too small to be seen, so that local therapy seems a waste of time. If on colposcopic examination only a few condyloma acuminata are located, then therapy is defendable. CO2 laser therapy should be preferred to other modalities until a systemic treatment is available and safe.
The peroxidase-antiperoxidase technique with the use of paraffin sections of 67 cervical biopsy specimens and an antiserum cross-reactive with all papillomaviruses provided immunologic confirmation for the observation that papillomavirus infection of the cervix is not uncommon and that it most often presents as a flat, colposcopically unremarkable lesion. Papillomavirus antigen was detected in 21 or 35 condylomata of the cervix. Antigen-positive nuclei were found in the upper layers of the epithelium. Electron-microscopic examination of five reprocessed antigen-positive sections revealed, in each instance, papillomavirus particles in the nuclei of the most superficial layers of the condylomatous epithelium. The viral antigen was not detected in dysplasia, carcinoma in situ, or invasive carcinoma.
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During a 34-month period 2050 fine needle aspiration biopsies of solid or cystic palpable breast lesions were performed. Of the 1182 patients with solid lesions, 384 underwent 405 surgical procedures. Carcinoma was the histologic diagnosis of 118 lesions. Of these, aspiration cytology had identified 92 (78%) as malignant; in 13 (11%) a malignant condition was suspected; 9 (7.6%) had been falsely assessed as benign. Cytology reports were accurate in 237 (83%) of the 287 histologically confirmed benign lesions. There were no false-positive reports. The 243 patients with cystic lesions underwent 572 aspirations for diagnosis and as treatment. Four lesions were excised and found to be benign. Needle aspiration biopsy is a most valuable tool. It is safe, simple, quick, repeatable and easily accepted by patients. Its positive predictive value is excellent (100% in our series). Cytology reports negative for malignant change should be disregarded if cancer is suspected clinically.
Age at first coitus and use of oral contraceptives were studied in a highly homogeneous population (French Canadian) during a cytologic cervical cancer screening program. Both factors were known in 84,540 women without cervical lesions and in 2017 patients with mild and moderate dysplasia. Highly significant correlations were found between: early onset of sexual activity and occurrence of dysplasia; oral contraceptive use and occurrence of dysplasia; early age at first coitus and oral contraceptive use. When correlated for age at first coitus, there was a significant excess of dysplasias in oral contraceptive users. Dysplasia of the uterine cervix behaves epidemiologically like carcinoma in situ and invasive squamous carcinoma, that is, essentially as a venereal disease. It remains to be seen whether all dysplasias form one continuum or whether there are two morphologically similar but biologically distinct forms of dysplasia: one more frequent, regressing spontaneously, the other relatively rare, progressing to carcinoma in situ and invasive squamous carcinoma of the cervix.
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To permit linkage of computerized patient data obtained from different sources, a universal and efficient method of patient identification is necessary. A coding system of 16 characters with a high degree of discrimination is proposed. The first five characters code the individual's family name, the next four his given name; the next six digits are his date of birth expressed in day, month and year; and the last character codes his sex. This system, using readily available patient information, is simple to manipulate and generates codes that are also medically informative. When this method of identification was tested on a list of 18,000 persons, no identical codes were found.
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