Angiogenesis in endometrial hyperplasia and stage I endometrial carcinoma

Citations from the literature/International Jour~l of Gynecology & Obstetrics j3 (19%) 205-214 compare the expression of the az-, as-, a,- and as-subunits of the &family of integrins in both the normal and the carcinomatous cervix. Study design: A total of 22 solid tissue specimens (18 cancer and 4 normal) were analyzed immunohistochemically. The double stain technique. used an avidin-biotin complex kit to identify the various integrins and alkaline phosphatase/anti-alkaline phosphatase kit to identify the epithelial cells. Staining intensity, the main outcome measured, was graded as absent, weak, moderate, or strong. Statistical analysis was performed with the Wilcoxon rank sum test for non-parametric data. Results:The az- and a,-integrins stained the normal cervix epithelium more intensely than the stroma (P = 0.03). The a4- and arintegrins stained both the stroma and the normal epithelium similarly. The az-integrin was absent in the stroma of all 18 cancer specimensdespite being present in the epithelial regions of 14-18 cancers. The as-integrin had a greater staining intensity in the stroma of the cancersthan in the epithelial regions (P = 0.002). Both a,- and as-integrins were absent in the epithelial regions of the cancers but present in the stroma. Conclusions:The distribution and intensity of integrin expression in cervical cancer differ from their expression in the normal cervix. In particular, the Bbronectin receptors a4 and as were absent in the epithelial regions of the cervical cancers, and as also had diminished expression in the malignant epithelium. These changes correlate well with the changesexpected in malignant transformation. Kapdsarcoma~Mavntvarma9s Macasaet MA.; Duerr A.; Thehno W.; Vernon SD.; Linger E.R. USA OBSTET GYNECOL 199586/4 II SUPPL. (695-697) Background Kaposi sarcoma has become a common manifestation in people with AIDS, especially men. A few reports of Kaposi sarcoma in women with AIDS have involved non-genital areas. However, of the few patients with genital Kaposi sarcomareported in the United States,none was beheved to be human immunodeficiency virus (HIV) positive. Genital Kaposi sarcoma associated with HIV has been reported in other parts of the world. Cure: A 29-year-old black woman presented with severe vulvar pain, vaginal discharge and a vulvar mass. She had been diagnosed with AIDS 25 months earlier. Biopsy of the vulvar mass revealed Kaposi sarcoma; viral analysis of the tumor was positive for herpes simplex virus type 2. Sequencing of polymerase chain reaction product verified the presenceof human papillomavirus 26. Conclusions: We report an HIV-associated Kaposi sarcoma presenting as a vulvar mass. This report should alert health care providers to include Kaposi sarcoma in the differential diagnosis of vulvar lesions. Sinplavidt program for cervIcaI cancer prevention In a hIghrIsk PHatiBurger R.A.; Monk B.J.; Van Nostrand K.M.; Greep N.; Anton-Culver H.; Manetta A. USA OBSTET GYNECOL 199586/4 I (491-498) Objective: To evaluate the feasibility of a single-visit cervical

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neoplasia screening and intervention program. Methodv: A sample of asymptomatic, non-pregnant, indigent, adult women who had not had a Papanicolaou smear for at least 2 years (n = 126) was recruited through Spanish-language media in Orange County, California. Women who volunteered underwent a free, single-visit program combining a heahh questionnaire, education, an immediately read Papanicolaou smear, loop eleotrosurgical excision of the transformation zone for those with dysplastic cytology, and an exit questionnaire gauging satisfaction and educational impact. Main outcome measuresincluded the frequency of cervical cancer risk factors and barriers to health care, incidence of cervical neoplasia, feasibility, short-term educational impact, and acceptability of interventions. Results: All 126 patients had at least one cervical cancer risk factor; 101(80.2%) reported at least one barrier to health care. One-hundred and sixteen (92.1%) had a normal Papanicolaou smear, and three (2.4%) with a mildly atypical smear were referred for colposcopy. Seven(5.6%) patients had a dysplastic smear and underwent same-day loop electrosurgical excision of the transformation zone without complication, with histology revealing koilocytotic atypia (two patients), cervical intra-epithelial neoplasia (GIN) I (two), CIN II (two), and CIN III (one). No case of invasive cervical carcinoma was identified. The mean time from performance of Papanicolaou smear to receipt of cytologic results was 2.2 h, and the mean total visit time was 3.6 h. Patients found the single-visit program to be both beneficial and satisfying. Coaelusions:This single-visit program is feasible and may overcome barriers to the diagnosis and management of cervical neoplasia in patients at high risk. ~Ilt~~hWb~aDdsbgeIcadomebiPl AbulatiaO.; Triest W.E.; Sherer D.M.; Hansen C.C.; Ghezzi F. IJSA OBSTET GYNECOL 199586/4 I (479-485) Objective: To evaluate angiogenesis in endometrial hyperplasia and stageI endometrial carcinoma, and to investigate the relationship between angiogenesisand tumor grade and depth of invasion. Methods: Three groups of patients were.analyzed: control patients who underwent hysterectomy for benign conditions (n = 19),patients with endometrial hyperplasia (n = 24), and patients with stage I endometrial carcinoma (n = 34). All hysterectomy specimenswere stained immunohistochemically for factor VIII-related antigen as a sensitive and specific marker for vascular endotheliwn. Areas close to the deepest myometrial invasion or those with the highest grade of enA dometrial hyperplasia and the highest angiogenic intensity were selected.Three fields (x 400) were selectedfor each slide, and the mean microvesselcount was calculated. Statistical analysis included Mann-Whitney U-test or Kruskal-WaBis analysis of variance and Dunn post hoc procedure. P < 0.05 was considered significant. Results: A significant difference was found between the microvessel count of controls versus the group with complex endometrial hyperplasia (median 21, range 16-80, vs. median 38, range 20-130; P < 0.05). Microvessel counts of complex endometrial hyperplasia were significantly higher than those of simple hyperplasia (median 25, range

212

Citations from the literature /International Journal of Gynecology & Obstetrics 53 (1996) 205-214

16-42; P < 0.0s) and significantly lower than counts of endometrial carcinoma (median 77.5, range 19-189; P < 0.05). Microvessel counts in complex hyperplasia were not signiIkantly merent than those of non-invasive stage I endometrial carcinoma (median 38, range 20- 130,vs. median 44, range 19-119, P = 0.5). In cases of stage I endometrial carcinoma, a higher number of microvessels was noted in qecimens with myometrial invasion than in those without myometrial invasion (median 44, range 19-l 19, vs. median 83, range 19-189; P < 0.01). A higher number of microvesselswas notedin~withgrade2thaninthosewithgradel,stageI endometrial carcinoma (median 44, range 19-98, vs. median %, range 63-189; P c 0.001). Conclusions: Complex endometrial hyperplasia and endometrial carcinoma are angiogcnic. Furthermore, in stage I endometrial carcinoma, greater depth of invasion and higher tumor grade are directly correlated with angiogenic intensity.

INFECTIOUS

DISEASES

I. Ilnpaet of antepuhal?rahga~taIprophyIaxkandIntrapartnnl EIlc Mercer B&I.; Ramsey R.D.; Sibai B.M. us.4 AM J OBSTET GYNECGL 1995 173/3I (837-841) Ob&ctive: Our purpose was to evaluate cumnt obstetric practice regarding screening and prophylaxis for group B Strcpmcoceusand to evaluate the impact of screening on antepartm and intrapartum care. Study design: A total of 1232 members of the Society of Perinatal Obstetricians were asked to indicate their practices regarding screening for group B Srreptococcus.Respondents were then asked their practices regarding antepart~ and intrapartum prophylaxis on the baais of screeningcultures, prior anti-microbial treatment and other risk factors for neonatal sepsis. Rest&s: Of the 925 respondents(75.10/o),30.8%performed routine screening in all pregnancks: first prenatal visit (42.3%),26 to 28 weeks (41.3%) and 34 to 38 weeks (22.1%). In addition, 65.9% would screen patients only under high-risk situations. Although 70.5% sampk multiple sites, respondentswere inconsistent regarding the sites from which cultures are obtained: distal vagina (64.2%), cervix (53.9%), proximal vagina (40.0%), anal canal (38.5%), and urethra (4.3%). A total of 34.7% of respondents would treat the patient at the time of a positive culture. Knowledge of maternal group B Srreptococcw carriage would significantly alter intrapartum prophylaxis in low-risk (60.3% vs. 0.5%) and various high-risk populations (74.0% to 98.4% vs. 11.3% to 55.0%). However, no consensus as to optimal practice was identi!kd. Conclusions:This survey demonstrates significant inconsistencies in screening and prophylaxis for group B Streprofoecusby specialistsin maternal-fetal medicine. In addition, it reveals that the recommendations of The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics are not routinely followed by these specidists. Knowledge of group B Sweprococcuscarriage sign& candy increases antepartum and intrapartum treatment PrematdecreubgforgroopBStreptoeoenra

regardlessof the presenceof other risk factors for neonatal sep sis. The impact of this practice on neonatal therapy warrants further evaluation. II. Impact of anteparhml screeningand propbyIaxk 00 DeooataIcare Mercer B.M.; Ramsey R.D.; Sibai B.M. USA AM J OBSTET GYNECOL 1995 173/3I (842-846) Objectives:Our purpose was to evaluate the current practice of anti-microbial prophylaxis of preterm and low-birth-weight infants and to determine the impact of intrapartum fever, group B Srreprococcuscarriage, intrapartum anti-microbial therapy and duration of membrane rupture on neonatal therapy. Study design:A total of 1356members of the American Academy of Pediatrics were asked their practice regarding neonatal screening and anti-microbial prophylaxis. Respondentswere asked to define how maternal fever, group B Srreprococmscarriage, intrapartum anti-microbial therapy, and prolonged membrane rupture would affect their decisions regarding neonatal therapy. Results: A total of 982 responseswere obtained (72.4%). Routine anti-microbial prophylaxis is given to asymptomatic preterm neonatesby 33.7% of pediatricians. Prophylaxis is inconsistently given at 32-36 weeks but is nearly universal after intrapartum fever, regardlessof intrapartum therapy. If empiric intrapartum prophylaxis was given before a preterm birth, both the incidence.(47.1% vs. 29.1%) and frequency of prolonged neonatal therapy (39.1%vs. 17.4% 2 7 days) would be increased. Knowledge of maternal group B Srreprococms carriage would lead to a 26fold increasein treatment (75.1%vs. 29.1%) and 1.8-fold increasein the incidence of prolonged therapy of preterm infants (30.9%vs. 17.4%),with 45.3%giving antibiotics for L I week if intrapartum treatment had been instituted. Surprisingly, 18% of pediatricians would treat term neonates without any risk factors other than maternal group B strep tococcal carriage, and 32.7%would continue treatment for h 7 days. The majority of pediatricians (82.6%) felt that intrapartum prophylaxis would reduce early onset group B streptococcal sepsis,but only 46.0% felt overall neonatal sepsiswould be decreasedby such therapy. Conclusions:Antepartum screening and intrapartum prophylaxis against group B Sireptococms by obstetricians may lead to an increased incidence and duration of treatment of preterm and term neonatesby the pediatrician. The efficacy, cost, and risks of such treatment in broadly applied screening and treatment programs should be considered before a standard of care is established.

Prenatal semming for group B Strept-

RI& factors for groap B streptococcal diseaseIn adults

Jackson L.A.; Hilsdon R.; Farley M.M.; Harrison L.H.; Reingold A.L.; Plikaytis B.D.; Wenger J.D.; Schuchat A. USA ANN INTERN MED 1995 123/6(415-420) Objective: To determine risk factors for community-acquired and nosocomial group B streptocoazal disease in adults. Design: Case-control study. Setting: Three metropolitan areas in the United Stateswith an aggregatepopulation of 6.6 million persons. Patients: Non-pregnant adults (219) with invasive