RESUMEN
BACKGROUND/AIMS: The human equivalent of mouse mammary tumour virus (MMTV-LV) may have a role in the pathogenesis of primary biliary cirrhosis (PBC) and breast carcinogenesis. We investigated MMTV-LV prevalence in patients with liver disease of diverse aetiology and associations with hepatic expression of hormonal receptors, p53 protein and complicating hepatocarcinogenesis. METHODS: Nested PCR for MMTV-LV envelope was performed using tissue from 210 patients with liver disease and 20 patients with histologically normal liver. Hepatic expression of estrogen receptor-alpha (ER-alpha), progesterone receptor (PgR) and p53 protein was determined by immunohistochemistry. MMTV-LV expression was also determined in hepatocellular carcinoma (HCC) tissue from 21 patients, in 11 of whom paired non-tumourous liver tissue was available for comparison. RESULTS: MMTV-LV envelope sequences were present in 25% (53/210) of liver disease biopsies but not in histologically normal liver (0/20) (P=0.02). There was no association between MMTV-LV presence and hepatic expression of ER-alpha or p53 protein. No liver sections were PgR positive. MMTV-LV prevalence was not significantly different in HCC tissue, paired non-tumourous chronic liver disease tissue from the same patients and liver disease tissue from patients without complicating HCC. CONCLUSIONS: Hepatic expression of MMTV-LV is evident in a wide range of non-cirrhotic and cirrhotic liver diseases, irrespective of ER-alpha, PgR or p53 status, and unrelated to complicating HCC.
Asunto(s)
Hepatopatías/virología , Hígado/virología , Virus del Tumor Mamario del Ratón/aislamiento & purificación , Animales , Atresia Biliar/virología , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/virología , Receptor alfa de Estrógeno/genética , Receptor alfa de Estrógeno/metabolismo , Femenino , Hepatitis/virología , Degeneración Hepatolenticular/virología , Humanos , Cirrosis Hepática/virología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/virología , Neoplasias Mamarias Experimentales/virología , Virus del Tumor Mamario del Ratón/genética , Ratones , Reacción en Cadena de la Polimerasa , Receptores de Progesterona/genética , Receptores de Progesterona/metabolismo , Transcripción Genética , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/metabolismo , Proteínas del Envoltorio Viral/genéticaRESUMEN
STUDY OBJECTIVE: To describe the effect of fertility-sparing laparoscopic excision of endometriosis and bowel resection on clinical and quality-of-life outcomes. DESIGN: Prospective observational cohort study (Canadian Task Force classification II-2). SETTING: Australian tertiary referral center for the surgical treatment of endometriosis. PATIENTS: Seven consecutive patients with known endometriosis involving the bowel. INTERVENTION: Laparoscopic resection of all endometriosis, including laparoscopic bowel resection with end-to-end anastomosis with or without temporary ileostomy. MEASUREMENTS AND MAIN RESULTS: Preoperative and 12-month postoperative data were collected by use of visual analogue scores for dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, and dyschezia. Validated research tools (SF12, EuroQOL, and Sexual Activity Questionnaire) also assessed quality of life. Reduction in median pain scores at baseline was demonstrated and at 12 months after operation for dysmenorrhea 71 (interquartile range 43-85) versus 5 (0-10); p=.028, nonmenstrual pelvic pain 74 (48-85) versus 11 (0-18); p=.046, dyspareunia 66 (0-98) versus 5 (0-8); p=.080, and dyschezia 48 (20-64) versus 20 (0-40); p=.173. All measures of quality of life were improved at 12 months after surgery, although not reaching statistical significance because of the small sample size. All three women wishing to conceive after operation have been successful, resulting in three live births at term. There were few complications associated with this surgery. CONCLUSION: Fertility-sparing laparoscopic excision of endometriosis with bowel resection results in improvements in all aspects of pain and quality of life. Results appear to parallel published data for conservative resection of endometriosis not involving bowel. For women with severe endometriosis involving bowel, this surgical treatment provides a viable alternative to pelvic clearance and successfully maintains fertility.
Asunto(s)
Endometriosis/cirugía , Enfermedades Intestinales/cirugía , Laparoscopía , Calidad de Vida , Adulto , Femenino , Estudios de Seguimiento , Humanos , Ileostomía , Proyectos Piloto , Estudios Prospectivos , Recto/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Transplacental transmission of human cytomegalovirus (CMV) can result in congenital malformations, although details on the mechanisms of transmission and the location of CMV in infected placentae need to be described.METHODS. Placental tissue from term (third trimester) deliveries was screened for CMV infection by polymerase chain reaction (PCR), in situ PCR (IS-PCR), and IS reverse-transcriptase PCR (IS RT-PCR).RESULTS. CMV DNA was detected in tissue samples from 11 placentae that had been determined to be negative for CMV during routine pathological examination. IS-PCR demonstrated the presence of CMV DNA in all cell types within placental villi, and IS RT-PCR further defined this result by identifying viral transcripts from all stages of replication. CMV DNA and RNA were shown to be highly concentrated in placental trophoblast cells. The infecting viruses were detected with primers specific for the major immediate early section of the genome (UL122/123), the UL21.5 virion gene, and the glycoprotein B (gB) gene and were determined to be predominantly genotype gB2. Therefore, maternal and fetal host factors, as well as viral load and possibly viral genotype, may all affect the outcome of placental CMV infection.CONCLUSION. Placental villi are involved in the transfer of blood from maternal to fetal circulation. Infection and replication of CMV within placental trophoblasts suggests that these structures may be involved in the transmission of CMV.