Background and Objectives: It has been suggested that bacterial vaginosis may play a role in the etiology of cervical neoplasia. The authors analyzed the prevalence, risk factors, and impact on histologic changes of bacterial vaginosis in women with cytological abnormalities of the uterine cervix. Methods: Two-hundred-eighty women with dyskaryotic smears were surveyed. Using a questionnaire, data were obtained on smoking habits and sexual history. Bacterial vaginosis was the diagnosis if the vaginal discharge produced a fishy odor upon alkalinization and if clue cells were seen in the wet smear. Cervical scrapes were analyzed for the presence of human papillomavirus DNA, and cervical tissue specimens were analyzed for the presence and severity of (intraepithelial) neoplasia and the proliferation rate (mitotic index) of the lesion. Chlamydia trachomatis was identified by culture of an endocervical swab. Results: Bacterial vaginosis was found in 56 (20%) out of the 280 women. The presence of bacterial vaginosis was significantly associated with the number of cigarettes smoked per day, age at first sexual intercourse, the lifetime number of sexual partners, and current Chlamydia trachomatis infection. The number of cigarettes currently smoked per day and the lifetime number of sexual partners were independent significant risk factors for the presence of bacterial vaginosis. There was no relation between the presence of bacterial vaginosis and the human papillomavirus infection. Bacterial vaginosis did not influence the severity of the (intraepithelial) neoplasia or the mitotic index. Conclusion: In women with dyskaryotic cervical smears, the prevalence of bacterial vaginosis did not seem to be increased, and bacterial vaginosis did not influence the histologic changes. Therefore, bacterial vaginosis is unlikely to be important in the etiology of cervical neoplasia, despite the similarity between its epidemiologic features and those of cervical human papillomavirus infection and cervical neoplasia.
The authors performed a cross-sectional epidemiological study on 181 women with a report of cervical cytological abnormality in order to find out whether the presence of oncogenic human papillomavirus was associated with the
Collisions between motor vehicles and child pedestrians are a leading cause of child deaths * This study showed a strong association between increasing risk of injury of child pedestrians and increasing traffic volume * High density of curb parking was also associated with greatly increased risk of injury * Transport policies that reduce traffic volumes in urban areas could substantially reduce rates of injury ofchild pedestrians * Restricting curb parking at crossing points may also be effective at reducing risk walking for shorter journeys.Children and their parents have traditionally been held responsible for the problem of child pedestrian safety.21Our results point to the responsibilities ofgovernment.
OBJECTIVE--To assess the relation between two risk factors for cervical neoplasia: smoking and infection with oncogenic human papillomavirus. It has been suggested that smoking causes a local immunological defect, which could facilitate the infection and persistence of human papillomavirus. DESIGN--Cross sectional epidemiological study. Completion of a structured questionnaire by the patients, analysis of cervical scrapes for human papillomavirus, and morphological examination of biopsy specimens. SETTING--Outpatient gynaecological clinic. SUBJECTS--181 women with a report of cervical cytological abnormality. MAIN OUTCOME MEASURES--Prevalence of infection with oncogenic human papillomavirus and smoking habits. RESULTS--Oncogenic human papillomavirus was found in the cervix of 26 (41%) of the 63 women who did not smoke, 22 (58%) of the 38 who smoked 1-10 cigarettes a day, 28 (61%) of the 46 who smoked 11-20 cigarettes a day, and 26 (76%) of the 34 who smoked > or = 21 cigarettes a day. The prevalence of the virus thus increased in accordance with the number of cigarettes smoked (p = 0.001). This relation remained after adjustment for age at first intercourse and lifetime number of sexual partners. Of the 63 non-smokers, 23 had previously smoked at least 10 cigarettes a day at some time. Of these 23 women, 14 (61%) had oncogenic human papillomavirus in their cervix. Of the 40 women who had never smoked at least 10 cigarettes a day, 12 (30%) had the virus. The prevalence of oncogenic human papillomavirus in non-smokers therefore depended on previous smoking habits (p = 0.03). CONCLUSION--The dose dependent effect of cigarette smoking on the occurrence of oncogenic human papillomavirus favours a causal relation between these risk factors for cervical neoplasia.
Summary The level of risk for carcinoma in the uterine cervix depends on the type of human papillomavirus (HPV) present. We examined whether the HPV type influences the proliferation rate and occurrence of mitotic figures with lagging chromosomes in the precursor of cervical carcinoma. The study group comprised 180 women who were referred because of cytologic changes indicating dysplasia and who were subsequently diagnosed with cervical intraepithelial neoplasia grade III. The HPV-16-associated lesions showed a significantly higher number of mitoses per 1.000 nuclei than the lesions without HPV (p < 0.001). The HPV-16-associated lesions also showed a significantly higher proportion of mitotic figures with lagging chromosomes than did the HPV-18− or HPV-31-associated lesions and lesions without HPV (p = 0.01. p = 0.007. and p = 0.002, respectively). Our results indicate that the differences in oncogenic potential among HPVs become apparent in the precursor lesion through the differences in the extent of chromosomal lag during mitosis.
SummaryThis study sought to show whether an increased mitoticindex (MI; i.e. the number of mitoses among 1000 nuclei) and the occurrence of particular atypical mitotic figures (AMFs) are characteristic of cervical squamous malignancy.The study group consisted of 24 cervical tissue specimens with microinvasive carcinoma (MIC). The intraepithelial and invasive parts were considered separately. The control group consisted of 82 cervical tissue specimens without neoplasia which were derived from two sources: 31 women were biopsied because of an abnormal cervical cytology report but no neoplasia was found histologically and 51 women underwent an hysterectomy for non-cervical uterine disease. Mitoses were only classified in proliferative lesions (MI⩾2). The mitoses were classified into normal mitotic figures (NMFs), lag type mitoses (LTMs), multipolar mitoses (MPMs) and other atypical mitotic figures (OAMFs). Particular attention was given to the two group metaphase (2GM), a member of the LTMs. In order to be 99 per cent confident of detecting any particular AMF which actually made up at least 2 per cent of the mitoses, 228 mitoses were classified in each area under study.
There is a need for additional morphologic criteria to improve the value of histologic classification for the prediction of the biologic behavior of cervical intraepithelial neoplasia (CIN). Representative slides from 72 cone specimens containing CIN were examined to study the correlation between the presence of three group metaphases (TGMs), a morphologically well defined and light microscopically readily recognizable atypical mitotic figure, and the incidence of aneuploid cells with a nuclear DNA content greater than 5C. The numbers of cells greater than 5C (minus the polyploid cells 8C +/- 1C) were counted, using LEYTAS image cytometry on Cytospin preparations from the 72 blocks corresponding to the slides searched for TGMs and used for histologic classification of the lesions in classes CIN 1-3. It appeared that large numbers of aneuploid cells greater than 5C were more closely related to the presence of TGM than to a higher CIN class per se, particularly in women older than 35. Since aneuploid CIN has a higher progression rate than euploid CIN, the presence of TGMs will indicate a biologically unfavorable lesion. Thus, TGM deserves further investigation as an additional morphologic parameter for predicting the biologic behavior of CIN.
