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Biomedical subjects

J Paavonen

Publications and source records attributed to J Paavonen.

At least 109 records · Page 6Linked to original sources
PubMed1995

Vulvodynia--a complex syndrome of vulvar pain.

Vulvodynia is a syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. The incidence of prevalence of this condition is not known. Several subtypes of vulvodynia have been recognized. Recognition of the distinct subsets of vulvodynia is a pre-requisite for successful management. Vulvar vestibulitis syndrome, cyclic vulvovaginitis, and dysesthetic vulvodynia are the most common subtypes. Other frequently misdiagnosed vulvar or vaginal conditions which can also cause culvodynia are vulvar papillomatosis, cytolytic vaginosis, lactobacillosis, and desquamative inflammatory vaginitis. In addition, many vulvar dermatoses can cause acute or chronic vulvar itching or pain, and are a frequent cause of differential diagnostic problems. In conclusion, vulvodynia is a complex multifactorial underdiagnosed clinical syndrome. Systematic epidemiologic, etiologic, and therapeutic studies of vulvodynia should be undertaken.

Candidiasis↗
PubMed1995

Diagnosis and treatment of vulvodynia.

Vulvodynia is a complex multifactorial and multidisciplinary clinical syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. Because of the absence of abnormal physical findings among such patients, vulvodynia was long thought to be solely a psychosomatic syndrome. The incidence or prevalence of vulvodynia has not been well studied. The recognition of specific subtypes of vulvodynia is important in the management of patients with vulvodynia. The most common subtypes are vulvar vestibulitis syndrome, cyclic vulvovaginitis and dysesthetic vulvodynia. Simple practice guidelines can be developed to facilitate the evaluation and management of such patients. Systematic epidemiological, etiological and therapeutic studies of vulvodynia are urgently needed.

Female↗
PubMed1995

A colposcopic scoring system for grading cervical lesions.

Colposcopic scoring systems have been used for distinguishing low-risk from high-risk cervical lesions. We studied 159 HPV DNA positive patients (7 with HPV 6/11, 51 with HPV 16/18, 52 with HPV31/33/35, 25 with mixed HPV types, and 24 with untypable HPV) (mean age 25.7 years, SD 7.4), and 69 age matched HPV-DNA negative control, patients, drawn from the same clinical setting. A dot-blot hybridization technique (ViraPap and VyraType, Digene Diagnostics, MD, USA) was used for HPV DNA hybridizations types 6/11, 16/18, and 31/33/35. Each patient underwent cytologic and colposcopic evaluation at four-month intervals. A colposcopic score for grading cervical lesions was used. It included features of lesion borders, tone of acetowhitening, and vascular atypia. Each feature was graded using three categories, so that an increasing score would be associated with gradually more severe lesions. The mean follow-up time was 12.2 months (SD 8.7) for the cases, and 12.8 months (SD 6.9) for the controls. The study end point was defined as the presence of cytologic changes consistent with CIN, in which case colposcopically directed biopsy and endocervical curettage were performed. The mean colposcopic score derived from the features of ATZ was 4.9 in the HPV DNA positive patients and 4.3 in the HPV DNA negative patients. The mean colposcopic score was 3.3 for those with HPV 6/11, 4.5 for HPV 16/18, 5.3 for HPV 31/33/35, 5.0 for mixed HPV types, and 4.0 for untypable HPV.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Vulvar and vaginal colposcopic pictures of human papillomavirus infection.

The recognition of both overt and subclinical vulvar HPV infection has become increasingly important. However, although molecular biological evidence has indicated a strong link between HPVs and cancer, clinical or epidemiological evidence is still not fully convincing. We studied 159 HPV DNA positive patients, using a dot blot hybridization technique (ViraPap and ViraType, Digene Diagnostics. USA), and 69 randomly selected HPV negative controls drawn from the same clinical setting, at the outpatient clinic, Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland. Seven patients had HPV 6/11, 51 had HPV 16/18, 52 had HPV 31/33/35 25 had more than one of the three HPV DNA groups ("mixed"), and 24 had untypable HPV DNA. Cases and controls were examined at four month intervals. The mean follow-up time was 12.2 months (SD 8.7) for the cases, and 12.8 (SD 6.9) for the controls. Although vulvar or vaginal abnormalities (acetowhite epithelium, squamous papillomatosis, filaments, satellite lesions, fissure, papules, or exophytic condylomas) were more commonly seen in the cases than in the controls, the difference was significant only for exophytic condylomas. In conclusion, colposcopy is not a good predictor of HPV infection and should not be used as an HPV screening test. HPV DNA hybrodization did not help more than the histopathologic findings in the diagnosis, but allowed the recognition of high-risk patients. The role of an accurate colposcopic examination with target biopsies remains essential.

Adult↗
PubMed1994

Altered growth behavior of human cervical epithelial cells transfected by HPV type 16 and 18 DNA.

Transfection of primary human cervical epithelial (HCE) cells with full-length HPV type 16 and 18 DNAs resulted in cell lines that could grow continuously. Four HPV DNA-immortalized cell lines were established. Morphologically the immortalized cells resembled primary HCE cells. Electron microscopy showed that they contained desmosomes and keratin filaments, which are characteristic structural components of epithelial cells. Each cell line had a unique integration pattern of HPV DNA but the transcription patterns were similar in the 3 HPV 16 DNA-immortalized cell lines. The expression patterns of viral DNA in the HPV 18 DNA-immortalized cell line were similar to that in HeLa cells, suggesting transcription of mainly early viral genes. The cell lines, unlike HeLa and SiHa carcinoma cells, did not form tumors in nude mice or grow in soft agarose, but collagen raft culture indicated that the immortalized cell lines had lost the capacity of normal differentiation compared with primary HCE cells. Morphologically, the aberrant differentiation of the immortalized cells showed great resemblance to cervical intra-epithelial neoplasia. The altered pattern of growth and differentiation of human cervical epithelial cells transfected by HPV 16 and 18 DNAs is in agreement with the view that HPV types 16 and 18 play an important role at an initial step of human cervical epithelial carcinogenesis but that co-carcinogenic factors are necessary for full malignant transformation in vivo.

Animals↗
PubMed1994

Antibody response to B cell epitopes of Chlamydia trachomatis 60-kDa heat-shock protein and corresponding mycobacterial and human peptides in infants with chlamydial pneumonitis.

To study antibody response to the hypersensitivity protein B of Chlamydia trachomatis, also known as the 60-kDa heat-shock protein (hsp60), epitope scanning was done over the entire protein. Human sera with antibodies to C. trachomatis identified 5 major antigenic regions (peptides 2, 5, 9, 17, and 21) and several minor regions (peptides 34-37, 39, 50, and 59-62). Clear-cut IgG antibody responses to chlamydial peptide 2 (YNEEARKKIQKGVKT) and a corresponding mycobacterial peptide (YDEEARRGLERGLNA) were found in 8 of 16 infants with chlamydial pneumonitis and in 1 of 18 controls. Peptide 50 (RLAKLSGGVAVIRVG) showed an 80% identity with its human counterpart (RLAKLSDGVAVLKVG), which was derived from human mitochondrial protein P1, but specific antipeptide antibody responses were found in 3 of 16 cases only. In summary, both IgG antibody response to C. trachomatis hsp60 and occasional autoantibody formation in infants with chlamydial pneumonitis were found.

Amino Acid Sequence↗
PubMed1993

Serum antibodies and subsequent cervical neoplasms: a prospective study with 12 years of follow-up.

Approximately 40,000 blood samples drawn in 1968-1972 by the Social Insurance Institution's mobile clinic in Finland have been stored. Linking cancer incidence data obtained from the Finnish Cancer Registry with this material yielded 32 cases of cervical cancer diagnosed after drawing of the blood sample. These 32 individuals and 64 matched controls were analyzed for serum antibodies indicative of past infection with Chlamydia trachomatis, Neisseria gonorrhoeae, cytomegalovirus, Epstein-Barr virus, and herpes simplex virus type 2. After adjustment for smoking and other sexually transmitted diseases, antibodies to C. trachomatis showed the strongest association with cervical cancer (odds ratio = 5.0 (95% confidence interval 1.6-15.7)), but the numbers were too small for drawing conclusions as to the sexually transmitted diseases with which cervical cancer is most specifically associated.

Adolescent↗
PubMed1993

Test performance of erythrocyte sedimentation rate and C-reactive protein in assessing the severity of acute pelvic inflammatory disease.

OBJECTIVE: The objective of the study was to evaluate the test performance of erythrocyte sedimentation rate and serum C-reactive protein in assessing the severity of acute pelvic inflammatory disease and to determine clinically useful cutoff levels to discriminate mild from severe pelvic inflammatory disease. STUDY DESIGN: The study population consisted of 72 women with acute pelvic inflammatory disease verified by laparoscopy and endometrial histopathologic studies; 37 patients had mild and 35 had severe pelvic inflammatory disease. Cutoff levels for erythrocyte sedimentation rate and C-reactive protein were determined to reach best sensitivity and specificity to discriminate between severe and mild disease. Clinical and microbiologic data were analyzed by chi 2, or t test. Logistic regression analysis was used to analyze risk factors for severe pelvic inflammatory disease. RESULTS: Patients with severe pelvic inflammatory disease had higher erythrocyte sedimentation rates and C-reactive protein levels than did those with mild disease. In detecting severe disease an erythrocyte sedimentation rate > or = 40 mm/hr and C-reactive protein levels > or = 60 mg/L had a sensitivity of 97%, a specificity of 61%, a negative predictive value of 96%, and a positive predictive value of 70%. All patients with tuboovarian abscess or perihepatitis and six of seven patients who had anaerobic bacteria isolated from the fallopian tubes tested positive with these cutoff levels. CONCLUSION: Combined use of erythrocyte sedimentation rate and C-reactive protein levels is useful in assessing the severity of acute pelvic inflammatory disease and augments the clinical decision making regarding treatment.

Acute Disease↗
PubMed1993

Evaluation of serum antibody response to a newly identified B-cell epitope in the minor nucleocapsid protein L2 of human papillomavirus type 16.

The aim of this work was to identify B-cell epitopes in the minor nucleocapsid (L2) protein of human papillomavirus (HPV) type 16 and characterization of allied antibody response. Serum samples of 513 individuals (323 women with various degrees of cervical atypia, 150 men and 40 small children) were available for the study. Synthetic peptides overlapping the L2 protein of HPV 16 twice were applied in ELISA for epitope scanning and antibody determination. An HPV 16 L2 derived dodecamer SGYIPANTTIPF (amino acids 391-402) proved to be the major B-cell epitope. Both IgA antipeptide antibody positivity (range 7-28%) and mean IgA antibody levels (range 13.2 EIU to 42.4 EIU, P < 0.05) increased with the degree of cervical atypia, whereas antipeptide IgG antibodies showed an opposite trend. During a 2-years follow-up significantly (P < 0.0005) decreasing IgA antibody levels to the SGYIPANTTIPF peptide were associated with regression of koilocytotic atypia. Analysis of anti-peptide IgA antibodies of 118 women with known HPV type revealed that a majority of positives had HPV 16/18 DNA. It was concluded that antibody response to the newly discovered peptide was partially type- and disease-specific. Our results also suggest an impairment of the IgG but not IgA class antibody response to HPV 16 in patients with persistent cervical HPV infection.

Journal Article↗
PubMed1993

Depletion of Langerhans cells in cervical HPV infection is associated with replication of the virus.

We studied the quantity of Langerhans cells in 36 patients with cervical human papillomavirus (HPV) infection. Significantly fewer Langerhans cells (p < 0.05) were found in patients with compared to those without DNA tetraploidy. Similarly, patients positive for HPV 16/18 DNA by in situ hybridization or antipeptide IgA antibodies to HPV 18 tended to have fewer Langerhans cells than those negative for HPV 16/18 DNA or IgA antibodies. Our results suggest that depletion of Langerhans cells is associated with productive HPV 16/18 infection in the cervical epithelium.

Antibodies, Viral↗
PubMed1993

Detection of serum antibodies to Chlamydia trachomatis in patients with chlamydial and nonchlamydial pelvic inflammatory disease by the IPAzyme Chlamydia and enzyme immunoassay.

A novel serological test, IPAzyme Chlamydia (Savyon Diagnostics Ltd., Beer Sheva, Israel), was compared with an enzyme immunoassay (EIA) for the ability to detect serum immunoglobulin G and A antibodies in the diagnosis of acute chlamydial pelvic inflammatory disease. In comparison with cell culture, which is the "gold standard," IPAzyme Chlamydia and EIA exhibited sensitivities of 63 and 68% and specificities of 76 and 87%, respectively. Thus, IPAzyme Chlamydia offers no advantages over the EIA, and neither serological test can be recommended for the diagnosis of acute Chlamydia trachomatis infection. So far, conventional cell culture remains the most reliable diagnostic test for chlamydial pelvic inflammatory disease.

Antibodies, Bacterial↗
PubMed1992

A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection.

BACKGROUND: Human papillomavirus (HPV) has been associated with cervical intraepithelial neoplasia, but the temporal relation between the infection and the neoplasia remains unclear, as does the relative importance of the specific type of HPV, other sexually transmitted diseases, and other risk factors. METHODS: We studied prospectively a cohort of 241 women who presented for evaluation of sexually transmitted disease and had negative cervical cytologic tests. The women were followed every four months with cytologic and colposcopic examinations of the uterine cervix and tests for HPV DNA and other sexually transmitted diseases. RESULTS: Cervical intraepithelial neoplasia grade 2 or 3 was confirmed by biopsy in 28 women. On the basis of survival analysis, the cumulative incidence of cervical intraepithelial neoplasia at two years was 28 percent among women with a positive test for HPV and 3 percent among those without detectable HPV DNA: The risk was highest among those with HPV type 16 or 18 infection (adjusted relative risk as compared with that in women without HPV infection, 11; 95 percent confidence interval, 4.6 to 26; attributable risk, 52 percent). All 24 cases of cervical intraepithelial neoplasia grade 2 or 3 among HPV-positive women were detected within 24 months after the first positive test for HPV. After adjustment for the presence of HPV infection, the development of cervical intraepithelial neoplasia was also associated with younger age at first intercourse, the presence of serum antibodies to Chlamydia trachomatis, the presence of serum antibodies to cytomegalovirus, and cervical infection with Neisseria gonorrhoeae. CONCLUSIONS: Cervical intraepithelial neoplasia is a common and apparently early manifestation of cervical infection by HPV, particularly types 16 and 18.

Adolescent↗
PubMed1992

Pre- and posttreatment serum antibody responses to HPV 16 E2 and HSV 2 ICP8 proteins in women with cervical carcinoma.

Serum antibodies to early proteins of human papillomavirus type 16 (HPV 16 E2 protein) and herpes simplex virus type 2 (HSV 2 ICP8) can be measured by ELISA. In the serum of 122 newly diagnosed cervical carcinoma patients and age-matched controls, enhanced IgA antibody levels to an HPV-16 E2 protein derived peptide no. 245 indicated a 9.5-fold (95% confidence limits 2.8-57.2) relative risk of cervical carcinoma. No significant risk was found with a corresponding HPV 6 E2 peptide or HSV 2 ICP8. To evaluate the HPV 16 E2 peptide as a possible tumor marker for cervical carcinoma serial postoperative serum samples were tested from 27 women with cervical carcinoma. Antibody responses to the HPV 16 E2 peptide depended on the clinical stage. Stage I and II patients showed decreasing posttreatment IgA and/or IgG antipeptide antibody levels. Stage III and IV patients initially showed decreasing antipeptide antibody levels followed by increasing levels. These patients also showed increasing IgG antibody levels to the HSV 2 ICP8. However, increasing antibody levels to the HPV 16 E2 peptide indicated significantly (P less than 0.05) worse 2-year disease free survival (recurring disease) than did stable or decreasing antibody levels. The results suggest that serum antipeptide antibodies to the HPV 16 E2 peptide no. 245 can be used for the monitoring of cervical carcinoma.

Adenocarcinoma↗