HPV and Abnormal Pap Smear Results

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Cutaneous viral infections

Research into the relationship between life stress and human papillomavirus (HPV) and human immunodeficiency virus (HIV) suggests that major psychosocial events are implicated in immune decrements in HPV infections and tendency to intraepithelial neoplasia (Pereira et al., 2003). Further studies on the stress management effects on psychological, endocrinological and immune functioning in men with HIV infection suggested that psychotherapy had measureable beneficial effects. A 10-week, group-based cognitive-behavioural stress-management intervention showed reductions in catecholamine urine output, urine cortisol output and beneficial changes in CD8 cytotoxic and CD4 lymphocytes (Hickie et al., 1999).

Squamous Cell Carcinoma

Fair-skinned individuals with excessive sun exposure. Other aetiological agents may be relevant, such as arsenic ingestion, human papilloma virus infection, polycyclic aromatic hydrocarbons, industrial carcinogens (tar, pitch, crude paraffin oil), previous radiotherapy and chronic ulceration. Lesions arising in sun-exposed sites have a low risk of metastasis but this is increased in tumours arising on the lower lip, in scars or ulcers, anogenital mucosa or in immunocompromised patients. These carcinomas usually present as slowly evolving plaques or nodules, which may become eroded or ulcerate, usually on the head (Figure 9.31) and neck. They can also occur in the genital area and oral mucosa. Surgical excision is the treatment of choice but adjuvant radiotherapy or node dissection are required in metastatic lesions.

Combination Oral Contraception

Combined oral contraceptives have the potential to be a highly effective method of contraception however actual user failure rates (8 ) are higher than perfect user rates (0.3 ). Many women have difficulty taking a pill every day, but other obstacles contribute to the failure rate. Insurance limitations on number of packs of pills prescribed, or state limitations on contraception coverage for poor women are also obstacles to using birth control appropriately. As well, many practitioners mistakenly believe that a pelvic examination and pap smear are required before refilling or initiating a prescription for combined hormonal contraception. In actuality, only a blood pressure measurement is required prior to initiating a combined hormonal method. Thus patient and provider education, and policy changes, are necessary to promote maximally effective use of COCs. It is partially because of the high failure rate of COCs that longer term methods of contraception have been developed and are...

Personnel And Patient Safetyplume

Since lasers used in cutaneous surgery until the most recent thermally cool devices essentially generate much focal heat or mechanico-acoustic waves, either splatter debris or smoke are often generated. The presence of acrid smoke generated from boiling and charred skin by the CO2 laser and the need to remove such obvious pollution (158-161) led to seminal discoveries of the nature of operative-generated smoke and splatter debris (162). Even though electrosurgical apparatuses used for decades produced visible smoke it had been tolerated without comment. This was clearly not so with the laser. Laser smoke or debris may contain tumor cells (163,164), blood, blood-borne pathogens such as papilloma virus or HIV (165-169), bacteria (170,171), particulates as small as 0.1 mm in diameter, and toxic gases including benzene, formaldehyde, and acrolein (154,158,160). For slower-moving particulates, such as those generated by CO2 laser, not only masks which filtered less than 0.3-0.1 mm...

Nucleotide Binding Domain

AAA family members have a nucleotide binding site reminiscent of Walker-type ATPases.52 In the S4 subfamily ofATPases the glycine-rich P-loop is always gly-pro-x-gly-x-gly-lys-thr (Box A) and the Mg2+ binding motif (Box B) almost always has the sequence asp-glu-ile-asp (Fig. 7.2). Nucleotidase activity has been reported for at least three RC ATPases, S4, S7, and S8.58-62 The Km for ATP hydrolysis by a GST-S4 fusion has been estimated at 5 M with a Vmax of approximately 7 pmoles min g protein.58,59 By contrast, Makino et al determined the Km for ATP hydrolysis by rat S8 at 35 M.62 This group also measured a Vmax for ATP hydrolysis similar to that of the yeast and human S4. The three ATPases, S4, S7, and S8, hydrolyze ATP, CTP, GTP, and UTP to the corresponding nucleoside diphosphates and inorganic phosphate. Unlike S4 and S8, whose nucleotide specificity resembles that of the rabbit reticulocyte regulatory and 26 S proteasome complexes, S7 exhibits a marked preference for ATP.60,63...

Structure Based Lead Discovery Methods

Furthermore, as noted earlier, the NMR spectra not only identify which fragments bind but also show near which residues these fragments lie. The SAR by NMR method has been used to find novel ligands for several proteins already including FK binding protein, papilloma virus E2, and strome-lysin.

Gene Delivery Approaches Viral Methods

Gene Delivery Viral Method

Ing application of intramuscular and ballistic plasmid DNA injection is in DNA-based immunization protocols. DNA-based vaccinations are being developed to prevent infectious diseases and cancer 40 . Cells that express a foreign protein and subsequently present that protein on their surfaces are more likely to produce a cell-mediated immune response. Such a response may be more important in fighting viral infections such as those caused by HIV, HSV, CMV, or RSV. Techniques that inject a foreign antigen usually yield an antibody-mediated response. Both the gene gun and direct intramuscular plasmid DNA injection are being used in protocols to immunize against HIV, hepatitis B and C, HSV, influenza, papilloma, tuberculosis, RSV (Rous Sarcoma virus), CMV, Lyme disease, Helicobacter pylori, malaria and Mycoplasma pulmonis.

An Overview of Female Infertility

Medical Algorithm

When evaluating a patient for infertility, ideally the medical history and physical exam are obtained from the couple. One must obtain a complete obstetrical and gynecological history from the female. The menstrual history is an excellent indictor of ovulatory status. A complicated obstetrical history may suggest the need for maternal fetal medicine consultation prior to initiating therapy, especially if the planned infertility treatment predisposes to multiple births. The gynecologic history can give clues about risk factors for tubal scarring (Chlamydia infection, surgery for endometriosis) or cervical factor infertility (ablation for abnormal Pap smear).

Assisted Reproductive Technology

STDs, PID, abnormal pap smears and subsequent treatment The evaluation of the infertile couple often includes a panel of screening tests. This includes a cervical Pap smear, maternal blood type and Rh, antibody screening, rubella status, RPR (syphilis), varicella status, hepatitis B, and cystic fibrosis. Screening for sexually transmitted diseases is also recommended for patients at high risk, and would include hepatitis C, HIV 1 and 2, HTLV, CMV, chlamydia, and gonorrhea.

Radioguided Surgery and Vulvar Carcinoma

Overall, carcinoma of the vulva is a relatively rare malignancy representing approximately 5 of all female genital tract cancers1 and 1 of all malignancies in women. The incidence has risen slightly over the past 50 years, perhaps because of an overall rise in the average age of women in the U.S.,2 or an increase in the prevalence of human papillomavirus (HPV) genital tract infection. The reported increase in vulvar carcinoma in situ, a precursor lesion, has nearly doubled from 1.1-2.1 per 100,000 woman-years between 1973 and 1987,3,4 mostly in younger women. Several infectious agents have been proposed as possible etiologic factors in the development of vulvar carcinoma, including various granulomatous infections, herpes simplex virus and human papillomaviruses (HPV). The molecular role of the human papillomavirus in cervical dysplasia and carcinoma as well as the association between viral induced vulvar condylomata and subsequent development of vulvar carcinoma has been well...

Proprotein Convertases And Cancerrelated Substrates

Inhibition of PCs resulted in inhibition of MT-MMPs processing. Furin trans-fection to low-grade SCC cell lines from head and neck, resulted in increased levels of MT1-MMP processing. After treatment of these furin overexpressing cells with CMK, furin-mediated MT1-MMP processing was greatly diminished 49 . Furthermore, several SCC head and neck cell lines become 50 to 70 less proficient in MT1-MMP processing after transfection with PDX- a high affinity inhibitor of furin and PC5 50 . These results were supported with transfection with a second furin specific inhibitor, furin pro-segment (ppfur). Transfection with ppfur resulted in reduction of Pro MT1-MMP cleavage 51 . On the other hand, the extracellular PACE4 was found to cleave MT2-MMP in murine SCC cell lines. When PACE4 expressing SCC and papilloma cell lines were treated with a specific antibody, their ability to process MT2-MMP was diminished 52 . This behavior does not seem to be restricted to SCC since astrocytoma cell lines...

Signal Amplification Techniques

The Hybrid Capture system utilizes a monoclonal antibody that selectively recognizes RNA DNA duplexes. It has been developed to recognize targets such as human papillomavirus (HPV) DNA. The principle of the Hybrid Capture system is shown in Fig. 12. DNA isolated from the specimen (e.g., a cervical swab) is extracted, dena-


It is sometimes overlooked that some common forms of cancer may be caused by infection. For example, stomach cancer is often brought on by infection with Helicobacter pylori. Infection with H. pylori, and hence stomach cancer, was especially common in Japan prior to the widespread availability of refrigeration (31,32). Liver cancer is related to hepatitis infection (both B and C strains of the virus), and, thus, reductions in liver cancer hinge on controlling infection as well as curbing excess drinking. A third example is infection by the human papilloma virus, which can cause cervical cancer (33).

Gene Fusion

Several fusions of binding and luminescent proteins have been produced and proposed as universal reagents for immunoassays or immunohistochemistry techniques. In particular, a fusion protein between protein A and GFP has been proposed as a reagent for Western blotting (Aoki et al. 1996). Alternatively, the IgG-binding domain of protein A (ZZ) was fused to obelin and utilized for developing quantitative assays of rabbit, mouse, and human IgGs, with the same sensitivity obtained with commercially available protein A-HRP conjugate (Frank et al. 1996). With a similar strategy, GFP was fused to the single-chain antibody variable fragment of antibodies of interest, such as the antibody specific for hepatitis B surface antigen (Casey et al. 2000), for the E6 protein of human papillomavirus type 16 (Schwalbach et al. 2000), or for the herbicide picloram (Kim et al. 2002). In all cases the fusion protein retained both binding and luminescence properties and was suitable for developing...

Parasitic Infection

After travel, women should be asked about travel history if they have recurrent gynecological symptoms or are in the process of an infertility workup or breast-mass evaluation. Parasitic worms such as Ascaris spp. amd Enterobius vermicularis have been found on Pap smear results. Amebiasis can result in ulcerating lesions and unusual vaginal disharge in some cases (Hammill, 1989). Breast masses are not always malignant they can be parasitic in a woman with the appropriate travel history (Sloan et al, 1996 Perez et al, 1997).


A careful history is of course essential to the management of any patient presenting with abnormal bleeding. The date of onset of the presenting episode and her prior menstrual history need to be determined along with the presence of concomitant symptoms of any kind. Also important are the patient's general obstetrical and gynecologic history, including her pregnancy and infertility history, prior pelvic surgeries, abnormalities noted on prior exams, Pap smear results, and contraceptive method. A history of any significant medical problems should be noted, and inquiries made about symptoms suggestive of endocrine and bleeding disorders and about family members having similar problems.

Penile carcinoma 153

A Chronic irritation is main risk factor. Human papilloma virus also implicated. A R Condyloma acuminata (e.g. warts, human papilloma virus), chronic infection of the foreskin (balanitis), smoking. Balanitis xerotica obliterans (a form of lichen sclerosus, a chronic inflammatory condition of the glans or foreskin), erythroplasia of Queyrat (a form of carcinoma in situ of the glans skin), Bowen's disease (intraepithelial carcinoma of the penile shaft). Biopsy Punch or excisional biopsy to establish diagnosis (differential condylomata acuminata, syphilitic chancre or rarely chancroid). Imaging CT or MRI scanning for evidence of spread.