[Detection of human papillomavirus DNA using hybrid capture does not allow sufficient triaging of recurrent atypical pap smear classified as Pap III D].
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Adolescent↗
Biomedical subjects
G Böhmer
Publications and source records attributed to G Böhmer.
Human papillomavirus testing in primary screening for cervical cancer of human immunodeficiency virus-infected women, 1990-1998.
OBJECTIVE: Women infected with the human immunodeficiency virus (HIV) have an increased risk of cervical neoplasia while the value of cytologic screening is limited due to a high prevalence of inflammatory disease. The study was conducted to determine whether testing for human papillomavirus (HPV) DNA could improve primary screening for cervical cancer of these patients. METHODS: One hundred thirty-eight HIV-infected women were examined between 1990 and 1998. Ninety-four patients with a total of 279 women-years were eligible for incidence evaluation. Colposcopy, cytology, and HPV DNA testing with the hybrid capture I assay were performed at each visit. RESULTS: Seventeen cases of high-grade cervical neoplasia were diagnosed at study entry and 13 developed CIN II or CIN III during follow-up. The hybrid capture I assay detected 94.1% of prevalent and 100% of incident high-grade neoplasia, while the corresponding sensitivity of Pap smears using CIN I or worse as the referral criteria was 82.3% for prevalent and 69.2% for incident high-grade neoplasia. Eleven of 13 patients who progressed to histologically confirmed CIN II/III tested positive for HPV DNA at study entry compared with 5/13 women presenting with any degree of cytologic atypia at recruitment. The Pap smears of 36/94 women remained normal throughout the study while 54/94 patients remained negative for high-risk HPV types. CONCLUSION: Hybrid capture I identified high-grade cervical neoplasia more accurately than the Pap smear and appeared to be beneficial for primary cervical cancer screening in HIV-infected women.
Adult↗
Effects of excitatory amino acids and neuropeptide Y on the discharge activity of suprachiasmatic neurons in rat brain slices.
Effects of L-glutamate, AMPA, NMDA and NPY on the discharge activity of neurons located in the ventral subdivision of the suprachiasmatic nucleus were examined in submerged coronal slices of the rat hypothalamus. All substances were bath applied. Application of L-glutamate (14 neurons examined) induced an excitatory response in 8 suprachiasmatic neurons (+248.9 +/- 122.24%, mean +/- S.E.M.; P < 0.001). A biphasic response, i.e. an initial transient excitation (+54.3 +/- 8.21%; P < 0.001) succeeded by an inhibition (-66.2 +/- 9.31%; P < 0.001), was observed in 6 neurons. Application of AMPA (36 neurons examined) resulted in an excitation of 31 neurons (+209.2 +/- 58.58%; P < 0.0001). Application of NMDA (57 neurons examined) induced an excitation in 34 neurons (+253.8 +/- 91.18%; P < 0.0001), but an inhibition in 8 neurons (-757 +/- 6.52; P < 0.0001). Biphasic effects of NMDA with an excitatory component (+58.7 +/- 9.94%; P < 0.0001) succeeded by an inhibitory component (-62.0 +/- 8.07%; P < 0.0001) were observed in 13 neurons. In 5 of 13 examined cases, the inhibitory component of neuronal responses to NMDA was significantly attenuated by the simultaneous application of strychnine (attenuation was 56%; P < 0.05). The application of NPY (40 neurons examined) induced significant effects on the discharge rate of 29 suprachiasmatic neurons. 18 of these neurons were inhibited (-59.3 +/- 6.39%; P < 0.0001) whereas 11 neurons were excited (+156.6 +/- 107.222%; P < 0.001) by NPY. In 8 of 11 neurons examined, the NPY-induced inhibition was significantly attenuated by 92% during simultaneous application of strychnine (P < 0.001). In 23 NPY-sensitive neurons, the discharge activity was also affected by NMDA. Neurons excited by NPY were also excited by NMDA (8 cells). In neurons inhibited by NPY, application of NMDA induced either an inhibition (3 cells) an excitation (5 cells) or a biphasic effect (7 cells). Results suggest a direct excitatory effect of AMPA, NMDA and NPY on suprachiasmatic neurons. In contrast, inhibitory actions of NMDA and NPY are considered induced by an activation of inhibitory interneurons. Antagonistic effects of strychnine suggest an involvement of glycinergic interneurons in a subpopulation of neurons inhibited by NMDA and in most neurons inhibited by NPY. The involvement of inhibitory mechanisms in photic entrainment of the circadian system is discussed. An integrative model of excitatory and inhibitory actions of EAA and NPY on suprachiasmatic neurons is proposed.
Animals↗
[TEMPLAS online spike detection with Windows NT in epilepsy monitoring].
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Brain↗
[HPV-Dna hybridization allows differentiation of cervix lesions in PAP III cytologic findings].
A repeat Pap smear as well as a smear for human papillomavirus (HPV)-DNA detection with the Hybrid Capture assay (Digene diagnostics/Murex, Burgwedel) were collected from 30 women with Pap smears recurrently classified as "Pap III". All patients underwent colposcopy and histological assessment. The repeat Pap smear distinguished correctly in 15, colposcopy in 19 and the Hybrid Capture assay in 27 cases between neoplastic and inflammatory lesions. All invasive neoplasms were positive for HPV-DNA. HPV typing seems to be a suitable non-invasive method for early selection of cervical lesions that need histological assessment in women with smears classified as "Pap III".
Adult↗
[Electrosurgical loop excision of the transformation zone in treatment of cervix neoplasia].
100 patients with CIN on referral Pap and with a distinct cervical lesion on colposcopy were treated with the loop electrosurgical excisional procedure (LEEP). Compared with 60 women who underwent cold-knife conization, the number of lesions classified as CIN-3 or more did not differ between the two groups (53% vs 53.3%). Severe haemorrhage and cervical stenosis were only observed after conization. Involvement of resection margins was found in 18% of all LEEP and in 16.7% of all cone biopsies. 3-12 months after LEEP the rate of cytologically and biopsy proven neoplasia was 2.2%. LEEP is a safe and effective procedure and should be used as the treatment of choice for distinct cervical lesions.
Biopsy↗
[Chemoembolization of hepatocellular carcinoma in cases of isolated liver involvement].
Chemoembolization is an effective treatment for hepatocellular carcinoma, giving results equally as good as surgical therapy for T2 tumours. Survival can be prolonged and side-effects can be reduced by combining Lipiodol and Gelfoam for chemoembolization, employing a modified technique, with repeated procedures, and using appropriate follow-up treatment. The toxicity of the procedure is acceptable, but it requires supportive therapy necessitating an intense interdisciplinary co-operation.
Aged↗
[Three-dimensional computerized tomography in trauma surgery. A case presentation].
Three-dimensional images of bone structures can easily be reconstructed from computed tomography data. The technique and the advantages of contemplating reconstructions of bone defects in different directions are described. A special software programme allows to combine all data which are given by the standard CT. The slice diameter is two millimetres. The reconstruction shows bone surfaces in all required views. In traumatic and orthopaedic surgery 3-D-CT is useful in the analysis, detection and preoperative planning of comminuted bone injuries of the spine, pelvis, knee, shoulder and the calcaneus. With this technique it is possible to see the bone in its topographic constellation, to observe fractures in unusual directions and to identify fragments from each other. The surgeon gets a lot of additional information which is helpful to decide on the incision, the reduction and the fixation of fragments. Undesirable effects during operation are reduced, which leads to a more accurate treatment and subsequent better results.
Accidents↗
Evidence for an involvement of NMDA and non-NMDA receptors in synaptic excitation of phrenic motoneurons in the rabbit.
The action of endogenous excitatory amino acids on phrenic motoneurons was studied in anesthetized, vagotomized, paralyzed and artificially ventilated rabbits. The NMDA receptor antagonists APV and ketamine, as well as the non-NMDA receptor antagonists GAMS and DNQX were administered by microinjection into the ventral horn of the spinal segments C3-C5. Injection of each antagonist resulted in a reversible reduction of the phrenic nerve activity. Results suggest an important function of endogenous excitatory amino acids in the excitation of phrenic motoneurons. NMDA as well as non-NMDA receptors are involved. The functional role of both receptor types in bulbospinal neurotransmission is discussed.
2-Amino-5-phosphonovalerate↗
Glycine receptor-mediated fast synaptic inhibition in the brainstem respiratory system.
The involvement of glycinergic neurotransmission in the central regulation of respiration was investigated by administration of specific receptor agonists and antagonists into the 4th cerebral ventricle of the rabbit. Central respiratory activity was assessed by cycle-triggered averaging of phrenic nerve activity (PNA). Glycine reduced the peak amplitude of PNA and increased the duration of the respiratory phases. Conversely, strychnine decreased the duration of both phases, being more effective in expiration. Strychnine converted inspiratory ramp activity to a decrescendo type of pattern, with the highest discharge activity present at the onset of the inspiratory phase. Strychnine induced tonic PNA lasting throughout expiration with a decrescendo type of activity. In many cases strychnine induce apneusis with tonic PNA being at a level of about 2/3 of its maximum value during control. We conclude that glycinergic neurotransmission is important for the maintenance of the respiratory rhythm as well as the generation of normal respiratory pattern. Glycine could be involved in phasic as well as tonic inhibitory neurotransmission within the central respiratory system.
Animals↗
GABAA receptor mediated fast synaptic inhibition in the rabbit brain-stem respiratory system.
The involvement of GABA mediated neurotransmission in the central control of respiration was investigated by administration of the specific GABAA receptor agonist muscimol and the specific GABAA receptor antagonist biculline into the fourth cerebral ventricle of the rabbit. Cycle-triggered averaging of the phrenic nerve activity (PNA) was used to quantify drug-induced changes of the central respiratory pattern. Muscimol reduced the peak amplitude of PNA and increased the duration of the respiratory phases. High amounts of muscimol led to a long-lasting but reversible central apnea. Bicuculline very effectively blocked the effects of externally applied muscimol. Blockade of intrinsically active GABAergic neurotransmission by bicuculline resulted in a multitude of effects. Peak amplitude of PNA increased whereas the duration of both inspiration and expiration decreased. In this respect, effects of bicuculline and muscimol were complementary. Bicuculline reduced the slope of the inspiratory ramp, increased postinspiratory activity and induced an augmenting type of discharge activity in the last part of expiration resulting in a smooth transition between expiration and inspiration. In some cases the respiratory modulation was completely lost and PNA became perfectly tonic. This 'apneustic' type of respiratory pattern could be transformed into rhythmic breathing by increasing the respiratory drive. We conclude that neurotransmission via GABAA receptors is important for the maintenance of respiratory rhythm as well as the generation of normal respiratory pattern.
Animals↗
[Coronary artery bypass operations. The surgical treatment of coronary heart disease].
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Coronary Artery Bypass↗
Concurrent fast and slow synchronized efferent phrenic activities in time and frequency domain.
In urethane-anesthetized or decerebrated vagotomized rabbits efferent multifiber activity of the phrenic nerve was investigated for synchronized activities both in time and frequency domains. When respiratory drive was steadily increased by either an elevation of end-tidal CO2 concentration or i.v. administration of 4-aminopyridine, medium-frequency oscillations (MFO) first increased, then decreased and finally became absent. The power of high-frequency oscillations (HFO) steadily rose with increasing respiratory drive. In contrast to HFO which revealed a unimodal spectral peak of mostly small bandwidth, the MFO spectrum in most cases consisted of a broad complex. This complex in some cases was composed of two distinct peaks, i.e. MFO were heterogenous. The low- and high-frequency fractions of the MFO complex were related predominantly to the first and last third of inspiration, respectively. Examination of the on-going multifiber activity of the phrenic nerve with an expanded time scale revealed that lower frequency MFO probably result from synchronized ramp-like wave activity during early and mid-inspiration. The duration of the observed ramps well matched the corresponding MFO frequency. We suggest that these ramps might result from propagated synchronized waves of high-threshold phrenic motoneurons. During the last part of inspiration, however, MFO, like HFO, resulted from burst-like synchronized discharge of phenic motoneurons. Thus HFO are superimposed on ramp-like and burst-like activity of the MFO. It is assumed that the decline of MFO at high respiratory drive may be due to the increasing strength of HFO bursts which interrupt ramp activity in the MFO range and thus let MFO appear 'invisible' to the recording electrode. Both MFO and HFO were visually detectable in postinspiration.
4-Aminopyridine↗
Serotonergic control of phrenic motoneuronal activity at the level of the spinal cord of the rabbit.
The role of serotonin (5-hydroxytryptamine, 5-HT)-mediated modulation of phrenic motoneuronal activity was evaluated by microapplication of 5-HT and methysergide into the phrenic nuclei of the rabbit. 5-HT facilitated phrenic nerve activity (PNA) considerably resulting in a long-lasting augmentation of the peak amplitude of integrated PNA. In contrast, the blockade of intrinsically active 5-HT by methysergide decreased PNA and led to a strong reduction of the peak amplitude of integrated PNA. MDL 72222 was ineffective. Blockade of 5-HT receptors by preceding administration of methysergide effectively abolished the effects of microinjected 5-HT. Respiratory timing was unaffected by both the agonist and the antagonist. These results suggest that a considerable portion of the facilitatory influence of caudal raphe nuclei on central respiratory activity takes place at the phrenic nuclei level.
Animals↗
Effects of corticotropin-releasing factor on central respiratory activity.
Effects of corticotropin-releasing factor (CRF) on central regulation of respiration were studied in urethane-anaesthetized, vagotomized, paralyzed and artificially ventilated rabbits. Injections of CRF into the IVth cerebral ventrile (i.c.v.) resulted in an increase of the neuronal tidal volume (nVt), but had only minor effects on the duration of respiratory phases. Microinjection of CRF into the ventral parabrachial region of the pons (pneumotaxic center) resulted in a reduction of nVt and of the respiration rate. Respiratory effects of CRF administered i.c.v. or into the pontine parabrachial region were antagonized by alpha-helical-CRF, indicating a receptor-mediated action of CRF. Respiratory effects of CRF were not significantly affected after blocking ganglionic transmission with chlorisondamine. Neither mean arterial blood pressure nor heart rate were significantly affected by the injection of CRF into the IVth ventricle or the rostral pons. Results suggest an involvement of CRF in the central regulation of respiratory movements. CRF may be involved in the adaptation of respiration to stress.
Anesthesia↗
GABAB receptor mediated effects on central respiratory system and their antagonism by phaclofen.
The role of GABAB receptors in control of central respiratory system was evaluated by cycle-triggered averaging of phrenic nerve activity (PNA) of the rabbit. Blockade of GABAB receptors of the caudal brainstem by intracerebroventricular administration of phaclofen augmented PNA, decreased the duration of inspiration and to about the same extent increased the duration of expiration thus unmasking intrinsically active GABA. Analogously, stimulation of brainstem GABAB receptors by exogenous baclofen decreased PNA. Preceding administration of larger doses of phaclofen could block the effects of baclofen. It is proposed that GABAB receptors are involved in tonic and phasic modulation of central respiratory activity.
Animals↗
Involvement of fast synaptic inhibition in the generation of high-frequency oscillation in central respiratory system.
During moderate hypercapnia, spectrum analysis of efferent phrenic nerve activity (PNA) of urethane anesthetized rabbits revealed high-frequency oscillations (HFO). The spectral peak (mean frequency 111 Hz) was reversibly eliminated by the glycine receptor antagonist strychnine administered into the 4th cerebral ventricle. In contrast, blockade of brainstem GABAA receptors by bicuculline did not abolish HFO but even reinforced or induced HFO. Thus, there is evidence that fast synaptic inhibition via glycine receptors is involved in the generation of HFO within the medullary respiratory center, whereas GABA may play a modulatory role.
Action Potentials↗
Evidence for a respiration-modulated cholinergic action on the activity of medullary respiration-related neurons in the rabbit. An iontophoretic study.
Effects of the iontophoretically administered cholinergic agonists acetylcholine, bethanechol and DMPP on the activity of medullary respiration-related neurons were examined in urethane-anaesthetized rabbits. Inhibitory effects prevailed over excitatory effects. Analysis of cholinergic effects by cycle-triggered averaging revealed three major types of neuronal responses: (i) constant alterations of spike-density throughout the whole period of activity ("constant effects"), (ii) effects increasing during the progression of the burst of discharge or effects restricted to a particular fraction of the burst ("phasic effects") and (iii) effects which were characterized by an excitation during one respiratory phase and an inhibition during the other phase ("bi-phasic effects"). The latter type of effects was observed in phase-spanning respiration-related neurons. Phasic effects were mainly observed in inspiration-related neurons which were predominantly inhibited by stimulation of muscarinic receptors. Inspiratory R beta-neurons in no case were phasically affected by cholinergic agents. The mean muscarinic inhibition of inspiration-related neurons increased with the progression of inspiration. The mean nicotinic inhibition of expiration-related neurons decreased with the progression of expiration. Results suggest that the efficacy of (i) a central inspiration terminating mechanism and (ii) the onset of discharge of expiratory neurons is modulated by acetylcholine.
Acetylcholine↗