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Human Papillomavirus Infection in Cervical Carcinogenesis and Emerging Therapies
Omer Devaja (Subspecialty fellow)*
Andreas J. Papadopoulos (Registrar)**
John Cason (Senior lecturer)#
Kankipati S. Raju (Director)*
Department of Gynaecologic Oncology, Guys and St Thomas' Hospital, London, UK*; Department of Obstetrics & Gynaecology, St Georges Hospital, London, UK**; The Richard Dimbleby Laboratory of Cancer Virology, United Medical Dental School (UMDS) Guys and St Thomas' Hospital, London, UK#.
Summary
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Cervical cancer is the second most common female malignancy in the world.
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There is strong epidemiological evidence to suggest that HPV infection of the cervix, most commonly by types 16 and 18, plays an important role in the development of precancerous and cancerous lesions.
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Increased understanding of the molecular mechanisms underlying HPV infection has led to the identification of possible targets for prophylactic and therapeutic intervention.
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Results of ongoing clinical studies evaluating these new strategies (HPV vaccines) are eagerly anticipated.
Editor's Comment
Rapid advances in molecular biology have resulted in a greater understanding of the role of HPV infection in the complex process of cervical carcinogenesis. In this timely review of the field, the possible implementation of molecular biological techniques in clinical practice is discussed, including primary and secondary screening for HPV and novel prevention/treatment strategies using HPV vaccines.
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Ultrasonic Monitoring of the Scarred Lower Uterine Segment during Pregnancy
B. Shakuntala Baliga (Professor)
Bindu Grover (Former resident Doctor)
Department of Obstetrics and Gynaecology, Lady Hardinge Medical College (LHMC), New Delhi, India
Summary
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Transabdominal ultrasonography (TAUS) was prospectively evaluated for the diagnosis of defects and abnormal thinning of the scarred lower uterine segment (LUS) during the third trimester of pregnancy.
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Thirty-one primigravidae and 40 women with a history of 1 previous lower segment caesarean section (LSCS) were delivered by LSCS and included in the final analysis.
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The LUS was significantly thicker in the primigravidae group compared with the previous LSCS group, both on ultrasonography (4.3 mm vs 3.8 mm; p < 0.01) and at laparotomy (4.7 mm vs 4 mm; p < 0.001).
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The specificity and sensitivity of TAUS were 1.0 and 0.88, respectively; the positive and negative predictive values for defects and abnormal thinning were 100% and 97%, respectively.
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TAUS of the scarred LUS during the third trimester of pregnancy is useful and reliable for the diagnosis of defects and abnormal thinning.
Editor's Comment
The results of this prospective observational study suggests that TAUS during the third trimester of pregnancy is safe and can detect defects in the scarred LUS with reasonable reliability. As such, TAUS may be useful in selecting women with a history of previous LSCS for a trial of labour for vaginal birth after caesarean section (TOL-VBAC).
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Ovarian Endometriomas - A Dilemma in Aetiology and Management
Pratap Kumar (Professor & Head)
Department of Obstetrics & Gynaecology, Kasturba Medical
College, Manipal, India
Summary
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Endometriomas are the result of (normal) cyclical bleeding from ectopic endometrial tissue, i.e. existing outside the uterus.
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The ovary is the most common site of endometrioma formation.
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Transvaginal ultrasonography aids diagnostic accuracy; definitive diagnosis is by histopathology (often during laparoscopy).
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Ovarian endometriomas require operative procedures such as lysis of adhesions, exposure of the cyst wall, and biopsy.
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All ovarian endometriomas must be examined histologically, since it is difficult to distinguish early malignant changes.
Editor's Comment
Ovarian endometriomas are usually formed by an invagination of the surface of the ovary; this distorts the ovarian anatomy, increasing the risk of pain and infertility. In this article, the author points out the limitations of therapeutic management and the need for surgical intervention in ovarian endometriosis.
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