RESUMEN
The purpose of this study was to determine the effectiveness of Lactobacillus-containing vaginal tablets in the treatment of bacterial vaginosis (BV) and in the restoration of a healthy vaginal flora. Thirty-nine women with BV were enrolled in a double-blind, placebo-controlled clinical trial. Patients received either one Lactobacillus-containing tablet or placebo daily for 7 days. Clinical criteria, vaginal Gram stain scores and symptoms were compared with those at the initial visit and those at completion of therapy and 2 weeks later. After completion of therapy, all of the patients in the Lactobacillus-treated group (n = 18) were free of BV, showing a normal (83%) or intermediate (17%) vaginal flora, as compared with only two patients free of BV with intermediate flora (12%) from among the 16 placebo-treated women (p <0.001). Two weeks after completion of therapy, treatment was successful (score <7) in 61% of Lactobacillus-treated patients as compared with 19% of those in the placebo group (p <0.05). In the treatment group, the total number of symptomatic patients and the intensity of their symptoms, in particular vaginal malodour, were significantly reduced at both follow-up visits. The data indicate that intravaginal administration of exogenous selected strains of lactobacilli can restore a normal vaginal microbiota and be used in treating bacterial vaginosis.
Asunto(s)
Lactobacillus , Probióticos/uso terapéutico , Cremas, Espumas y Geles Vaginales/uso terapéutico , Vaginosis Bacteriana/terapia , Adulto , Poliaminas Biogénicas/análisis , Método Doble Ciego , Femenino , Humanos , Estadísticas no Paramétricas , Vagina/microbiología , Vaginosis Bacteriana/diagnósticoRESUMEN
BACKGROUND: The prognostic variability in breast cancer patients prompted the authors to investigate specific biological markers for the identification of high-risk breast cancer groups. In the present study, attention was focused on the interaction between tumor cells and the extracellular matrix, an important requisite in the metastatic process. MATERIALS AND METHODS: Fifty-six primary breast carcinoma specimens obtained by mastectomy or quadrantectomy plus axillary dissection were examined with immunohistochemistry, for the determination of laminin, collagen type IV and hormone receptor expression and with static cytometry, for the determination of the DNA content. RESULTS: Laminin and collagen type IV expression was observed on the membrane and in the cytoplasm of neoplastic cells. Laminin and collagen type IV were present, respectively, in 85.4% and 73.8% of the cases which showed recurrence. CONCLUSION: The results of this study have shown that high expression of laminin and collagen type IV may have a value in the prognosis of disease free survival and may be linked to other classical clinical, histological and biological parameters in the evaluation of breast cancer patients.
Asunto(s)
Neoplasias de la Mama/metabolismo , Carcinoma Ductal de Mama/metabolismo , Carcinoma Lobular/metabolismo , Carcinoma Medular/metabolismo , Colágeno/biosíntesis , Laminina/biosíntesis , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/genética , Carcinoma Lobular/patología , Carcinoma Medular/genética , Carcinoma Medular/patología , ADN de Neoplasias/análisis , Progresión de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Receptores de Estrógenos/biosíntesis , Receptores de Progesterona/biosíntesisRESUMEN
A pilot study has been carried out to evaluate women's compliance to a screening program for cervical cancer. The study, initiated in 1994, was performed in conjunction with the ACRO project of the CNR by the Italian National Health Institute, in collaboration with La Sapienza University of Rome and the National Institute for Cancer Research in Genoa. A preliminary telephone survey was carried out on a sample of 400 women (200 in Rome and 200 in Genoa) to assess, among other factors, their attitude towards the screening program. Afterwards, an ad hoc advertising campaign was launched and 21,827 women, randomly chosen from the register office's lists, were sent a personal invitation to participate in the screening. Most women showed interest in attending the screening program at the interview, but the percentages of participation were low (25.7% in Genoa and 27.3% in Rome). On the other hand, a high percentage of women who participated in the screening had already had a Pap test in the previous three years (Genoa, 73%; Rome, 76%). The recruiting techniques that were used in this study, and that are commonly used, do not seem to reach the core of the target population for cervical screening, i.e. women who have never had a Pap test or who had a Pap test more than 5 years earlier. New methods of recruiting aimed at categories at risk and based more on direct contacts need to be developed.
Asunto(s)
Educación en Salud/organización & administración , Encuestas Epidemiológicas , Tamizaje Masivo/organización & administración , Programas Nacionales de Salud/organización & administración , Folletos , Selección de Paciente , Neoplasias del Cuello Uterino/prevención & control , Frotis Vaginal , Adulto , Anciano , Actitud Frente a la Salud , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiología , Femenino , Educación en Salud/economía , Educación en Salud/métodos , Humanos , Italia/epidemiología , Tamizaje Masivo/economía , Tamizaje Masivo/psicología , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Proyectos Piloto , Servicios Postales , Prevalencia , Evaluación de Programas y Proyectos de Salud , Distribución Aleatoria , Ciudad de Roma/epidemiología , Factores Socioeconómicos , Teléfono , Población Urbana , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Frotis Vaginal/psicología , Frotis Vaginal/estadística & datos numéricos , Displasia del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/epidemiologíaRESUMEN
DNA ploidy and thymidine-labeling index (TLI) have been introduced as prognostic indicators to characterize the biological behavior of breast cancer for the selection of patients eligible for adjuvant therapy. The aim of this study was to evaluate the prognostic significance and correlation between ploidy status, TLI and other common histopathologic parameters such as histotype, stage, grading, lymph node metastasis, hormone receptors and recurrence. DNA ploidy and TLI were assessed for 68 breast cancer patients, 27 to 85 years of age. DNA histograms, analyzed with static cytometry, were: diploid in 21(31%) and non diploid in 47 (70%). High TLI values were observed in 16 cases (24%), medium values in 46 cases (68%) and low values in 6 cases (8.5%). DNA ploidy and TLI showed a statistically significant correlation, as independent parameters, with recurrence (respectively, p = 0.0267 and p < 0.0001). Therefore, DNA ploidy and TLI may be considered additional prognostic parameters to be utilized besides all the other clinical-pathologic data for the assessment of these lesions, and to plan therapeutic strategies.
Asunto(s)
Neoplasias de la Mama/genética , ADN de Neoplasias/análisis , Ploidias , Timidina/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , ADN de Neoplasias/biosíntesis , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , PronósticoRESUMEN
BACKGROUND: In the past years, morphological indexes and kinetic parameters have been introduced to characterize breast cancer in order to select breast cancer patients for adjuvant therapy. The alterations of the proliferative activity of neoplastic cells and DNA ploidy may provide important information about the aggressiveness of the lesion and may be used as powerful prognostic factors. In fact, prognostic information based on the classic clinico-pathologic parameters such as histotype, stage and grade are no longer sufficient to select patients for long term follow-up. The aim of this study was to evaluate the malignant potential of neoplastic cells through the determination of modifications of the proliferative index and the evaluation of DNA ploidy. METHODS: Forty-five breast cancer patients, 32 to 80 years of age, were studied. Proliferative indexes and DNA ploidy, besides the other clinical-pathologic parameters have been evaluated. The proliferative index was assessed with the immunocytochemical determination of Ki67 and quantified with the CAS 200: 31 cases had a high proliferative index, 12 medium and 2 low. DNA ploidy was analyzed on cytologic preparations with static cytometry utilizing an image analyzer CAS 200: 13 cases were diploid, 32 non-diploid. RESULTS: A close relationship was found between Ki67 expression and DNA ploidy. In fact, lesions with a high proliferative index were all non-diploid, whereas, those with a low proliferative index were all diploid. Lesions with a medium proliferative index were 2 diploid and 1 non-diploid. Among the 45 cases, studied in a follow-up period of 36 months, 12 showed disease recurrence; 3 showed a medium Ki67 expression and were diploid, 9 a high Ki67 expression and were all non-diploid. CONCLUSIONS: In conclusion, proliferative indexes and DNA ploidy may be considered additional prognostic parameters which may potentially influence the clinical behaviour of breast cancer and may be utilized besides all the other clinico-pathologic data to assess these lesions.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Replicación del ADN , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/inmunología , Neoplasias de la Mama/patología , Femenino , Humanos , Persona de Mediana Edad , Ploidias , Pronóstico , Antígeno Nuclear de Célula en Proliferación/inmunologíaRESUMEN
BACKGROUND: The different clinical evolution of breast cancer with similar pathological characteristics prompted the authors to investigate the prognostic significance of different biological markers. METHODS: Seventy-one primary breast carcinoma specimens obtained by mastectomy or quadrantectomy were examined for the determination of the p53, nm23 and Ki67 expression, with immunohistochemistry, and the DNA content, with static cytometry. RESULTS: p53 protein was expressed as nuclear staining in 58% of the cases and was associated with high levels of Ki67, non-diploid lesions and lymph-node status. Positive staining for nm23 was significantly correlated only with histologic grading. A predictive role in disease recurrence was demonstrated only in patients with a high Ki67 nuclear expression. CONCLUSIONS: From these data, we may conclude that, besides all the other traditional clinical morphological parameters, a panel of different biological markers, such as Ki67 and the determination of p53 expression, may be utilized to further characterize breast cancer and its biological behavior.
Asunto(s)
Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Antígeno Ki-67/biosíntesis , Ganglios Linfáticos/metabolismo , Proteínas de Unión al GTP Monoméricas/biosíntesis , Nucleósido-Difosfato Quinasa , Factores de Transcripción/biosíntesis , Proteína p53 Supresora de Tumor/biosíntesis , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/genética , ADN/metabolismo , Femenino , Humanos , Inmunohistoquímica , Cinética , Metástasis Linfática/genética , Persona de Mediana Edad , Nucleósido Difosfato Quinasas NM23 , Ploidias , Pronóstico , Estudios ProspectivosRESUMEN
BACKGROUND: The importance of travel as a risk factor for Chlamydia trachomatis infection was evaluated among a series of young people consecutively tested. METHODS: We studied 130 sexually active young subjects, aged 14-25 years, all living in the Rome, Italy, urban area. Ninety-eight females and 32 males attended hospital-based clinics or were the partners of an infected female. About half of these subjects had traveled abroad either for pleasure or for work, mostly to Europe, but also to North America or to Asia, where they admitted to having had casual sex. We used two "gold standard" methods to diagnose infection with C. trachomatis: culture on McCoy cells grown in shell vial, and direct immunofluorescence with monoclonal antibodies. Subjects were considered infected when at least one test was positive. RESULTS: Thirty-nine of 130 (30%) subjects were asymptomatic, and 27/130 (20.8%) subjects were infected with Chlamydia trachomatis, of whom 6/25 (24%) asymptomatic females and 3/14 (21.4%) asymptomatic males were infected. Among teen-aged (ages 14-19) youngsters with more than one sex partner, international travel was an additional significant risk factor for C. trachomatis infection (p<.02; OR 20; 95% CI 1.47-40%). Urethritis/cystitis and vaginal pathology/discharge were the prevalent manifestations of illness among the females, while urethritis was the only clinical condition found in the males. CONCLUSION: In a series of young subjects, travel abroad, sex with more than one partner, and teen age, combined together, were significant risk factors for the acquisition of Chlamydia trachomatis genitourinary infection.
Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/aislamiento & purificación , Enfermedades de Transmisión Sexual/epidemiología , Viaje , Adolescente , Conducta del Adolescente , Adulto , Distribución de Chi-Cuadrado , Infecciones por Chlamydia/diagnóstico , Intervalos de Confianza , Femenino , Técnica del Anticuerpo Fluorescente Directa , Humanos , Italia/epidemiología , Masculino , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Enfermedades de Transmisión Sexual/diagnósticoRESUMEN
Intramammary lymph nodes appear in routine mammograms and are present in about 5% of patients undergoing mammography. Normal lymph nodes appear with ultrasonography, as well defined echo-poor masses with echogenic centers. This case report is an example of ultrasonography guided with FNA cytology in the diagnostic procedure of non-palpable breast lesions on an outpatient basis and choice of adequate therapy.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma in Situ/patología , Carcinoma Lobular/patología , Anciano , Biopsia con Aguja , Femenino , Humanos , Ganglios Linfáticos/patologíaRESUMEN
Recent studies have shown that microsatellites instability (MI) has a leading role in the development of different types of cancer: a high rate of di-tri or tetranucleotide repeats have been found in familial polyposis and in sporadic colorectal, gastric, breast and endometrial carcinomas. In the present study, we selected the DNA of 23 histological samples from patients with uterine leimyomas, aged between 24 and 65 years. The negative portion was divided from the pathological portion in the same sample of each patient. Each sample was analyzed for 7 microsatellites (D25123, Mfd39, 635. 636. Mfd67, D11S905, SCZD1 and DM) through double amplification with the PCR using external and internal primer couples. Seven of 23 samples analyzed on the denaturant gel of acrylamide (30.4%) were positive for microsatellite alterations. The recurrence of these alterations, which appear in our study, suggest their involvement in benign transformation of smooth muscle cells.
Asunto(s)
Leiomioma/genética , Neoplasias Uterinas/genética , Adulto , ADN de Neoplasias/genética , Femenino , Humanos , Repeticiones de Microsatélite , Persona de Mediana EdadRESUMEN
Solid tumors such as colorectal adenocarcinomas consist of biologically diverse cell subpopulations. Nuclear DNA content of tumor cells in colorectal carcinomas may be studied with different techniques of intranuclear DNA quantification. In the current study, the DNA ploidy of samples obtained from 68 patients with colorectal carcinoma (age ranging from 46 to 86 years, mean age 66 years), treated with radical surgery, between the years 1992 and 1995 was analyzed. DNA ploidy was assessed using a CAS 200 image analyzer and was evaluated on neoplastic tissue and undamaged healthy mucosa obtained from the edges of the surgical resection. Approximately 150-300 cells were analyzed for each sample. The aim of this study was to evaluate the prognostic significance of the polyclonal cases correlated with lymph node infiltration and disease free-survival. The pathological stage according to the TNM classification was compared to ploidy: an increase in multiple stemlines was observed in stage III cases, i.e., a progression towards aneuploidy and multiple stemlines was significantly associated with lymphatic metastasis (p<0.0003). Concerning distant metastasis, we found a correlation between stage IV and polyclonality. A significant correlation was observed between disease-free survival and aneuploid and polyclonal cases (p<0.0053). In polyclonal cases a nine fold greater relapse risk compared to the non-polyclonal cases was observed (p<0.0004). In two cases, the adeno-carcinoma of the sigma was polyclonal and its hepatic metastasis contained the predominant aneuploid clone with the same cytometric characteristics (DNA index) of the original lesion.
RESUMEN
Breast cancer is a common malignancy and the modalities and the aggressiveness of treatment strategies are variable and depend on information regarding the biological characteristics and behavior of an individual tumor. Therefore, to improve overall survival it is important to identify and select lymph node negative patients at high risk who would benefit from adjuvant therapy. Besides prognostic factors such as lymph node status, hormone receptor status and histopathologic parameters, nm23 antimetastatic gene and the p53 protein were studied in 32 breast cancer patients. Positive staining for nm23 was inversely associated with lymph node involvement in 82.4% of the cases. Most of the non-diploid lesions (70.8%) showed a high protein expression. Positive immunostaining for p53 was present in 28.1% of the cases and was strongly correlated with prognostic indicators such as necrosis and histologic grading. Tumor grade, DNA ploidy and lymph node metastasis were not significantly correlated with p53 protein expression. In this study, all the prognostic indicators studied, satisfactorily explain the important characteristics of the biologic behaviour of breast cancer, but the detection of lymph node metastasis is still the most accurate prognostic factor utilized for a predictive role in disease recurrence.
RESUMEN
In order to further characterize fine needle aspiration cytology of breast proliferative lesions, we analyzed 723 FNA of patients with palpable breast abnormalities who underwent physical, mammographic and/or echographic examination. In 28 biopsies (3.9%), the final cytologic diagnosis was a proliferative lesion, a group of uncommon breast proliferative diseases not yet explored, in which cytology is sufficiently cellular with plenty of atypical elements but not suspicious of carcinoma. Histologic material was available in 22 cases and represented the basis of this retrospective evaluation. Among the positive proliferative lesions (PPL), 10 cases were infiltrating ductal carcinomas and 1 was a microinvasive carcinoma; whereas for the negative proliferative lesions (NPL), in 8 cases the histologic findings demonstrated fibrocystic changes, in 1 a fibroadenoma and in 1 a cystosarcoma phyllodes. The cytologic criteria utilized to define breast proliferative lesions were the following: increased cellularity, occasional single atypical cells, decreased cellular cohesion, crowded, enlarged and overlapping nuclei with three dimensional groupings with prominent nucleoli and chromatic changes. The cytologic characteristics examined demonstrated that the PPL are characterized by single atypical cells with nuclear alterations such as coarsely granular chromatin with a thick nuclear membrane and numerous prominent nucleoli. These features are common to many malignancies, therefore surgical biopsy confirmation is suggested.
Asunto(s)
Biopsia con Aguja , Neoplasias de la Mama/diagnóstico , Mama/patología , Enfermedad Fibroquística de la Mama/diagnóstico , Adulto , Anciano , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/patología , Recuento de Células , Femenino , Fibroadenoma/diagnóstico , Fibroadenoma/patología , Enfermedad Fibroquística de la Mama/patología , Humanos , Persona de Mediana Edad , Tumor Filoide/diagnóstico , Tumor Filoide/patología , Estudios RetrospectivosRESUMEN
In the present study we evaluated the prognostic significance and correlation between ploidy status, lymph node status, estrogen-progesterone receptor status and the expression of Erb-B2 and p53 protein in 77 primary breast carcinomas. Quantitation of DNA ploidy was determined on Feulgen-stained touch imprints with an image analyzer, whereas localization of the immunohistochemical reaction of Erb-B2 and p53 protein was evaluated in paraffin-embedded tumor specimens with microscopy. The DNA histogram was diploid in 17 cases, poly/tetraploid in 24 and aneuploid in 36. We observed no correlation between ploidy status and hormone receptor content or lymph node status. The expression of Erb-B2 protein was observed exclusively in the membrane and in the cytoplasm of neoplastic cells and was uniformly distributed. Overexpression was observed in 89.2% of cases. Aneuploid tumors intensively expressed the oncogene in 20.3% of cases. A statistically significant correlation was observed between lymph node metastasis and Erb-B2 overexpression. The expression of p53 protein was expressed as nuclear staining in 17.6% of the cases, with variable intensity, mainly in ductal histotypes. Among these, 62% were aneuploid. Lymph node status and steroid receptor status did not correlate significantly with p53. From these data we conclude that DNA ploidy and Erb-B2 and p53 expression correlate with cell proliferation and differentiation and therefore may identify breast carcinoma patients with more aggressive disease.
Asunto(s)
Neoplasias de la Mama/genética , Ploidias , Receptor ErbB-2/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Femenino , Humanos , Inmunohistoquímica , Metástasis Linfática , Pronóstico , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismoRESUMEN
Two specific monoclonal antibodies for breast tissue (DF3 and MCAb-12) and the corresponding tumor markers CA15-3 and MCA in serum have been evaluated in 50 patients with breast cancer and in 15 controls. The expression of these antigens in tissue was poorly correlated with the common prognostic parameters. Their presence in serum was associated with an altered distribution of the antigens in the cell. The expression of these antigens in tissue enables us to select patients for serological follow-up and to evaluate tumor differentiation from a functional point of view.