ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In the past year, new data have been published on the molecular biology of human papillomavirus infections and their relationship to cervical neoplasia. As molecular techniques have become more sophisticated and as the molecular knowledge of human papillomavirus infections has been pursued in greater depth, it is increasingly apparent that this human tumor DNA virus is similar to a number of other oncogenic DNA viruses that have been described and well studied. These viruses appear to act through a common pathway of producing oncogenic proteins that interfere with key signalling elements that normally control the process of cell division. With a better mechanistic knowledge, it should be possible to design new therapeutic approaches to treating human papillomavirus-associated disease that are directed toward specific cellular events such as turning off the production of E6 and E7 proteins or restoring the activity of pRB or p53. Increased attention has also been turned to immunologic aspects of HPV infections, and a number of groups are eagerly pursuing the possibility of using simple office-based procedures to detect specific proteins encoded for by the human papillomavirus open reading frames in an attempt to determine who has been infected, is actively infected, and has proteins being produced that are indicative of neoplasia. From the clinical point of view, the use of outpatient excisional techniques such as the loop electrosurgical excision procedure is rapidly supplanting ablative techniques because of their superior ability to identify early invasive carcinomas and adenocarcinomas in situ that have not been detected by colposcopy. There has also been a substantial amount of investigation directed toward a better understanding of the role human papillomavirus plays in immunocompromised individuals—particularly those suffering from human immunodeficiency virus infection, with or without acquired immunodeficiency syndrome. Finally, it is becoming increasingly clear that the distinction between flat condyloma and cervical intraepithelial neoplasia grade 1 on the one hand and cervical intraepithelial neoplasia grade 2 and cervical intraepithelial neoplasia grade 3 on the other cannot be supported by molecular, histologic, or clinical data. Investigators increasingly are viewing cervical cancer precursors as a two-disease process—low grade cervical intraepithelial neoplasia and high-grade cervical intraepithelial neoplasia—rather than the conventional three-step (cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2, cervical intraepithelial neoplasia grade 3) process.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Human immunodeficiency virus infection has now reached epidemic proportions in both industrialized and nonindustrialized countries. Two preventive measures remain of questionable benefit: mandatory testing and partner notification. Sexually transmitted diseases and cervical ectopy may be risk factors for heterosexual transmission, now the most frequent mode of transmission of human immunodeficiency virus worldwide. Smokable freebase cocaine, the use of which is increasing in many cities in industralized countries, is associated with acquisition of sexually transmitted diseases and human immunodeficiency virus infection. In addition to perinatal transmission of human immunodeficiency virus, postnatal transmission via breastfeeding has been demonstrated in association with a recent acquisition of human immunodeficiency virus by the mother. Intriguingly, in multiple pregnancies, first-born twins of human immunodeficiency virus-infected mothers could be at higher risk of infection than second-born twins. Nosocomial transmission of human immunodeficiency virus, both from infected patients to health professionals and from infected health professionals to patients, is a matter of concern and justifies preventive measures.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Cytomegalovirus remains the most common congenital infection worldwide, with approximately 1% of all newborns infected in utero. Of those infected in utero, approximately 10% will have signs and symptoms of cytomegalovirus infection at birth and develop sequelae, especially mental retardation, hearing deficit, or both. Recent data indicate that more than 90% of symptomatic infections or infections causing sequelae occur following a primary maternal infection during pregnancy. The overall risk of delivering an infant who will develop significant handicaps following a primary maternal infection is between 10% and 20%. Between 1% and 2% of seronegative women may acquire a primary cytomegalovirus infection during pregnancy, but seronegative women at high risk include day-care workers, who have a 10% to 20% annual infection rate, and the seronegative mothers of infected children under 2 years of age, 50% of whom will acquire cytomegalovirus annually from their children. Adolescents are another group who may have a high infection rate during pregnancy. Although a cytomegalovirus vaccine is still many years from introduction, these observations strengthen the need and feasibility for a cytomegalovirus vaccine. Pending vaccine development and evaluation, several possible strategies for intervention to prevent primary infection for high-risk pregnancies are suggested.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This review discusses current reports on herpes simplex virus infections as they relate to the use of laboratory testing, infections in the neonate, herpes simplex virus association with human immunodeficiency virus infection, and updating the current therapy and management of genital herpes. Findings over the past year are important in the clinical management of patients with genital herpes. All health care workers who manage patients with genital herpes need to know the limitations of serologic testing. Current information suggests that serologic commercial testing that is most commonly available cannot discriminate between infections caused by herpes simplex virus type 1 and type 2. Laboratory methods still rely on culturing herpes simplex virus in living cells in vitro. However, the availability of monoclonal antibodies allows for rapid assays for the confirmation of cultured herpes simplex virus. In addition, assays have been developed and tested, suggesting that perhaps antigen-detection systems may be available that could replace culturing the virus in living cells. New information on neonatal herpes points out the predictors of morbidity and mortality in newborns who contract herpes within the first few weeks of life. Information concerning asymptomatic shedding in labor will provide the clinician with a better understanding of this disease entity in the pregnant woman. Several studies have confirmed that herpes simplex virus infection is a risk factor for developing human immunodeficiency virus infection. A new study clearly shows that treatment using daily acyclovir therapy over a prolonged period of time can control and may modify herpesvirus infection.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Pelvic inflammatory disease is a common serious complication of the sexually transmitted pathogens Neisseria gonorrhoeae and Chlamydia trachomatis. There are more than 800,000 cases of pelvic inflammatory disease annually accounting for approximately 200,000 hospital admissions for acute and chronic infections. Early accurate diagnosis and treatment are essential to prevent the serious sequelae including ectopic pregnancy, tubal disease infertility, chronic pain, and disability requiring multiple hospitalizations and surgery. Although clinical models to aid in the diagnosis and management of pelvic inflammatory disease have been developed by numerous investigators, all have lacked the sensitivity and specificity to be helpful to the clinician. Laparoscopy, considered by many to be the “gold standard” for diagnosis, is underutilized, and the definition of pelvic infection differs between investigators. Improved patient compliance and safety may be seen if single-agent therapy for acute pelvic inflammatory disease becomes a reality. In a small prospective randomized study, oral ofloxacin was as effective as cefoxitin plus doxycycline for outpatient treatment of chlamydial and gonococcal pelvic inflammatory disease. Treatment of tuboovarian abscess appears to be successful with single agent and combination therapy. Risk factors for developing postabortion endometritis continue to be identified, and the most efficacious prophylactic antibiotic regimen has not been determined to date.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The use of gonadotropin-releasing hormone agonists as adjunctive therapy with gonadotropins for ovulation induction in in vitro fertilization and other assisted reproductive technologies has become common clinical practice. With the recent advent of potent gonadotropin-releasing hormone antagonists free from the marked hista-mine-release effects that stymied earlier compounds, an attractive alternate method may be available. We have established the feasibility of combining gonadotropin-releasing hormone antagonist-induced inhibition of endogenous gonadotropins with exogenous gonadotropin therapy for ovulation induction in a nonhuman primate model. Here, the principal benefits to be gained from using the gonadotropin-releasing hormone antagonist rather than the gonadotropin-releasing hormone agonist are the immediate inhibition of pituitary gonadotropin secretion without the “flare effect,” which brings greater safety and convenience for patients and the medical team and saves time and money. We have also recently demonstrated the feasibility of combining gonadotropin-releasing hormone antagonist with pulsatile gonadotropin-releasing hormone therapy for the controlled restoration of gonadotropin secretion and gonadal steroidogenesis culminating in apparently normal (singleton) ovulatory cycles. This is feasible only with gonadotropin-releasing hormone antagonists because, unlike gonadotropin-releasing hormone agonists, they achieve control of the pituitary-ovarian axis without down regulation of the gonadotropin-releasing hormone receptor system. This capacity to override gonadotropin-releasing hormone antagonist-induced suppression of pituitary-ovarian function may allow new treatment modalities to be employed for women who suffer from chronic hyperandrogenemia with polycystic ovarian disease.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Transvaginal follicle puncture under sonographic control has become the method of choice for ovum retrieval worldwide. Because it is the current technology of the 1990s, there are very few reports in the literature on other methods of oocyte retrieval. Furthermore, perhaps because of the simplicity of transvaginal follicle puncture under sonographic control, there are only a few reports on the technique itself in the current literature. This review classifies the papers on hand according to general studies of the subject, appropriate anesthesia, necessity of follicle flushing for oocyte retrieval, vaginal disinfection and the evaluation of the risk following transvaginal oocyte retrieval, and new techniques in connection with the harvesting of oocytes.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Whether one carefully and meticulously records detailed observations in the laboratory, or jumps feet first into new and exciting areas of investigation, each scientist contributes to the advances being made in the control of human reproduction. The study of spermatozoa, oocytes, sperm-oocyte interaction, preembryo growth and development, and early pregnancy rewards us with breakthroughs in innovative technology and promotes paths of better understanding. One cannot search through the massive amounts of currently available literature without desiring to try “this” technique, expound on “that” one, take someone else's work a little further, or look at one's own results from a different angle. Presented here are some informative data, most published within the past year. Oocyte maturational competence and integrity, sperm function and quality, preembryo culture conditions, preembryo morphology, and ovarian age all emerge as factors important for interpreting a patient's chance of achieving pregnancy.

ISSN:1040-872X    

出版商:OVID    

年代:1992

数据来源: OVID