Objective To evaluate the expressions of biomarkers p16 and K i -67 in low-grade (LG) or high-grade (HG) lesions, and to relate them to risk factors and the recurrence of these lesions. Methods A retrospective case-control study of 86 patients with LG and HG lesions who underwent a loop electrosurgical excision procedure (LEEP) between 1999 and 2004. The control group was composed of 69 women with no recurrence, and the study group, of 17 patients with recurrence. All patients were followed-up over a two-year period after surgery, and screened every six months, including cytology and colposcopy. Biopsy samples collected from LEEP were submitted to immunohistochemical analysis for p16 and K i -67. The statistical analysis was performed using the Statistical Package for the Social Sciences software (SPSS, IBM-SPSS, Inc., Chicago, IL, US), with a significant p < 0.05. Results The biomarkers p16 and K i -67, separately or combined, showed no relation to recurrence on the total analysis. However, evaluating specifically HG lesions, the positive expression (2þ and 3 þ ) of p16/K i -67 was associated with recurrence (0.010). In addition, p16 isolated was also more expressive in HG lesions (2þ and 3 þ , p ¼ 0.018), but it was unrelated to recurrence. Conclusion Proteins p16 and K i -67, both isolated and combined, are not reliable primary markers for the recurrence of cervical lesions in the majority of LG lesions. However, analyzing only the group with prior diagnosis of HG lesions, the expressions of p16 and of p16/K i -67 were associated with recurrence, and they may be useful in monitoring these cases. IntroductionThe search for markers to facilitate the diagnosis of diseases is a constant in scientific research to save resources, time and to prevent unnecessary treatments. Cervical cancer is the most common cancer among women in 45 countries of the world and, worldwide, 266 thousand women die of it each year; 1 it is preceded by cervical lesions that may or may not progress to invasion. They are associated with infection and with the persistence of the human papillomavirus (HPV) to progress to invasive carcinoma. 2 Through this process, the cells infected with high-risk oncogenic HPV alter the cell cycle, modifying the production of proteins p16 and K i -67. The most common treatment for high grade (HG) lesions is cervical cone resection using the loop electrosurgical excision procedure (LEEP). A major concern of the treatment is the recurrence of the lesion, as it may reappear without symptoms and more severely. Proteins p16 and K i -67 are, respectively, cell progression and proliferation markers. Protein p16 is a tumor suppressor from the Ink4a family that induces the hyperphosphorylation of the retinoblastoma protein (pRb), and has low expression in normal tissues.3 K i -67 is a nuclear protein present in cells during the active proliferation stage, but it is not expressed when cells are in the quiescent state. 3 The expression of both molecules simultaneously already denotes some problem in the cell c...

The frequency of STIs was high in asymptomatic patients. Infections by HPV and were independently associated with the presence of CIN. The high frequency of STIs in asymptomatic women suggests the need for routine screening of these infections.

Fatores de risco de recidiva de lesões intra-epiteliais cervicais após conização por cirurgia de alta freqüência em mulheres portadoras e não portadoras do vírus da imunodefi ciência humanaRisk factors for cervical intraepithelial lesions after loop electrosurgical excision procedure in HIV-infected and non-infected women Objetivos: avaliar os fatores de risco associados à recidiva das lesões intra-epiteliais, após conização do colo com cirurgia de alta freqüência. Métodos: estudo caso-controle aninhado em coorte de 201 pacientes que se submeteram à conização com cirurgia de alta freqüência por apresentarem lesão intra-epitelial cervical, acompanhadas, em média, por dois anos. Participaram 94 portadoras do HIV e 107 não-portadoras do vírus. A conização cervical foi realizada por cirurgia de alta freqüência e a peça cirúrgica encaminhada para exame histopatológico, que avaliou o grau da lesão, as margens e a ocupação glandular. Após a cirurgia, as pacientes foram examinadas a cada seis meses com citologia oncótica e colposcopia. Foram consideradas recidivas as lesões que, após a cirurgia, foram confi rmadas novamente por biópsia. Neste estudo, foram considerados casos as pacientes com recidiva e controles as sem recidiva. As comparações entre os grupos foram realizadas pelo teste do χ 2 e a análise multivariada pela regressão logística. Para a análise de sobrevida foi utilizado o método de Kaplan-Meier (teste log-rank). Resultados: houve recidiva das lesões em 40 pacientes. As variáveis que inicialmente apresentaram signifi cância estatística foram: número de parceiros, soropositividade, margens do cone e envolvimento glandular, como indicadores do risco para recidiva. A ocorrência simultânea de ocupação glandular e margens comprometidas apresentou as recidivas mais freqüentes. Após análise pela regressão logística, permaneceram signifi cativamente associados à recorrência das lesões: ocupação glandular (OR=9,1; IC a 95%:13,0-27,5); presença do HIV (OR=4,6; IC a 95%:1,1-6,3); margens comprometidas (OR-2,6; IC a 95%:1,9-11,2). Conclusões: os fatores de risco associados à recidiva das lesões intra-epiteliais cervicais foram: soropositividade, ocupação glandular e margens comprometidas. PALAVRAS-CHAVE:Neoplasia intra-epitelial cervical; Conização; Infecções por HIV; Recidiva local de neoplasia; Displasia do colo do útero Abstract Purpose: to evaluate risk factors associated with cervical intraepithelial lesion recurrence after LEEP conization. Methods: nested case-control study in a cohort of 201 patients with cervical intraepithelial lesion, that were submitted to LEEP conization. Average follow-up of these patients was 2 years. Ninety-four HIV-infected women and 107 non-infected were enrolled. Cervical conization was achieved by the Loop Electrosurgical Excision Procedure (LEEP). Evaluated surgical biopsy histopathological characteristics were lesion grade, lesion borders and glandular involvement. After surgery all patients were submitted to a colposcopy and cytological evaluation every six months. Recurrent lesi...

Cervical intraepithelial neoplasias (CINs) are a major public health issue. The prevalence of CINs is higher in women with the human immunodeficiency virus (HIV). The objective of this study was to determine whether there are differences in the immune responses in the cervical stroma of HIV-infected and -uninfected women with CIN. The responses were assessed according to the immunohistochemical expression of cytokines interleukin (IL)-4, IL-12, interferon gamma (IFN-γ), and tumor growth factor beta (TGF-β). In addition, we determined whether there were differences in the local immune responses between patients with CIN1 and CIN 2/3. A cross-sectional study was performed using material collected by cervical conization in HIV-infected and -uninfected women with CIN. The conization was performed using loop electrical excision procedure (LEEP) from January 1999 to May 2004. The evaluation of cytokines in the cervical stroma was based on immunohistochemistry. No differences were found between the two groups of women regarding HIV status. However, the associations between IL-12 expression and CIN 2/3 (p=0.016) in HIV-infected women and between IL-4 expression and CIN 1 (p=0.0456) in HIV-infected women were significant when the interaction between HIV infection and lesion grade was assessed. Additionally, a significant association between TGF-β expression and CIN 2/3 in both groups was observed regardless of HIV infection (p=0.000). An interaction between HIV infection and CIN grade was detected because IL-12 and IL-4 expression increased in the presence of HIV infection. Regarding the CIN grade, there was a high prevalence of TGF-β in CIN 2/3 lesions, which reflected the predominance of an immunoregulatory environment.

Operating room v Conscious and oriented v Hemodynamically stable under noradrenaline perfusion v A balanced general anaesthesia was performed (fentanyl, etomidate, rocuronium and sevoflurane) v Percutaneous valve prosthesis was removed and a bioprothesis was surgically implanted in pulmonary position v She remained hemodynamically stable and no complications arose