No abstract

Patients contemplating using the new oral anticoagulants should be informed about specific clinical situations that could pose a bleeding risk such as the need for emergency surgery because no reliable antidote is available to stop the bleeding, which could prove fatal.

Integration of human papillomavirus (HPV) DNA into host genome occurs early in cancer development and is probably an important event in malignant transformation of cervical cancer. The HPV genome integration usually disrupts E2 gene open reading frames. It results in the lack of E2 gene suppressor of the synthesis of E6 and E7 products which, in turn, leads to the overexpression of E6 and E7 genes. The oncogenic HPV types (HPV16, -18, -45, and -58) can be present as episomes or may integrate into human chromosomes. Sixty-six cervical cancer patients positive for HPV16 were tested for the presence of E6, E2, E1, and L1 genes. Multiplex PCR was carried out in all cases. Using cluster analysis, the calculated ratios of E1/E6, E2/E6, L1/E6, E1/E2, and E2/(E1*E6) gene amplification products were divided into two or three statistically different groups. These were used for statistical analysis of the prevalence of specific gene types in histological types of cancer, different levels of clinical staging, and histologically confirmed nodal metastases. The statistical analysis proved a significant correlation in the ratios of E2/E6 and E1/E2 only. The E2/E6 and E1/E2 were higher in carcinoma in situ than in advanced squamous cancers. The E2/E6 ratios were lower in higher clinical stages. The multiplex PCR estimation of the E2/E6 ratio could be a simple method for selecting patients with a high risk of a poor outcome in a standard stage-dependent treatment procedure.Human papillomaviruses (HPV) are small (ϳ8 kb) DNA viruses that cause warts and proliferative lesions in epidermal tissues. Infection of the anogenital tract by these viruses is associated with several premalignant and malignant lesions, especially dysplasia and carcinoma of the uterine cervix (18). HPV infection is the most frequent sexually transmitted disease worldwide, and up to 60% of sexually active women will become infected by HPV in the genital tract (19). Even in a healthy population, the incidence of HPV infection varies from ca. 20% in Brazil to ca. 3% in Belgium and Poland (17,25). About 40 types of HPV with affinity to anogenital epithelium are known so far. HPV types 16, 18, 31, and 33 are considered the most important in the process of cervical cancerogenesis (12, 16). Genomic integration of an HPV DNA correlates with increased viral gene expression and cellular growth advantage (8). Integrated forms of HPV genomes are found much more frequently in cervical cancers than in cervical intraepithelial neoplasia cells (9, 14). These observations are consistent with the hypothesis that integration provides a selective advantage to cervical epithelial precursors of cervical carcinoma (8). During a common infection and in most premalignant lesions, HPV is in an episomal state (5). However, most cervical carcinomas and the cell lines derived from them maintain the HPV genome in an integrated form or in both integrated and episomal forms (3, 6). The genome integration of HPV usually disrupts E2 gene open reading frames (6, 9). It results in the lack of E...

Aims: The purpose of this prospective study was to describe the incidence and distribution pattern of human papillomavirus (HPV) DNA in intraoperative dissected lymph nodes and to relate this to the pathological confirmation of metastasis. Methods: Samples of primary cervical cancer lesions and dissected lymph nodes were obtained from women undergoing surgical treatment. The presence of HPV DNA was detected by the polymerase chain reaction. Results: Tissue from 79 tumours and 365 lymph nodes was analysed. Metastasis to the lymph nodes was found in 19 cases. Metastasis correlated with the volume of the primary lesion, the depth of cervical and vaginal invasion, and with invasion of the corpus. HPV DNA was found in 60 of the primary lesions and 31 of the lymph nodes. The presence of HPV DNA in the lymph nodes correlated with the volume of the primary lesion and vaginal invasion. Conclusions: The incidence of HPV DNA in lymph nodes is twice as high as that of histopathologically confirmed metastases. The risk of the presence of HPV DNA and histopathologically confirmed metastases in lymph nodes is related to certain features of the primary tumour.C arcinoma of the uterine cervix, the fourth most common cancer among women worldwide, is one of the most important health issues for women. Infection with certain oncogenic types of human papillomavirus (HPV) is considered a prerequisite for the development of the disease.1 The involvement of HPV in the development of cervical cancer is well established.2 3 In recent years, there has been growing interest in HPV because of the emerging evidence of its oncogenic potential, particularly in the anogenital tract.1 4 The prevalence of HPV infection in cervical cancer tissue is estimated to be in the range of 90%, and according to the Eurogin Committee it may be up to 99%. 6In a previous study, we found a lower prevalence in our region. 7Early detection of the preinvasive states of the disease leads to uncomplicated treatment and a good survival rate. Unfortunately, in Poland most cervical cancers are detected at advanced, invasive stages. The patients mostly undergo radical hysterectomy (Piver III). The survival of patients after radical hysterectomy depends on several factors, such as tumour size, histological tumour type, lymph node involvement, and the surgeon's skill. 8 9 The most important predictive factor seems to be the metastasis status of pelvic lymph nodes. Nevertheless, there are some patients with histopathologically negative pelvic nodes who unexpectedly have recurrences and a short life expectancy. Several studies have focused on the correlation between HPV status and lymph node involvement.1 10-12 Most have involved hybridisation 1 13 or the polymerase chain reaction (PCR) to detect HPV-16 and HPV-18. ''Unfortunately, in Poland most cervical cancers are detected at advanced, invasive stages''The purpose of our prospective study was to describe the incidence and distribution pattern of HPV DNA in intraoperatively dissected lymph nodes and pathologically confirme...