Human papillomavirus (HPV) is the etiologic agent for cervical cancer. In Mexico, a women dies every 2 h, and since 1990 the statistics have shown that the numbers of deaths are increasing. We conducted a phase II clinical trial to evaluate the potential use of the MVA E2 recombinant vaccinia virus in treating high-grade lesions (CIN 2 and CIN 3) associated with oncogenic papillomavirus. Fifty-four female patients with high degree lesions were treated either with an MVA E2 therapeutic vaccine or with conization. Thirty-four women received the therapeutic vaccine, at a total of 10 7 virus particles per dose injected directly into the uterus once every week over a 6-week period. Twenty control patients were treated with conization. By colposcopy, 19 patients out of 34 showed no lesion, in three patients the lesions were reduced by 85-90%, in eight other lesions had reduced by 60%, and in four more patients, they were reduced by 25%. Histological analysis showed total elimination of high-grade lesions in 20 out of 34 patients after treatment with MVA E2. Eleven patients had a 50% reduction in lesion size. In two other patients, the lesion was reduced to CIN 2 and in one more patient the lesion was reduced to low grade (CIN 1). All patients developed antibodies against the MVA E2 vaccine, and generated a specific cytotoxic response against papilloma-transformed cells. DNA viral load was significantly reduced in MVA E2-treated patients. Conization eliminated the lesions in 80% of the patients, but patients did not develop cytotoxic activity specific against cancer cells and did not eliminate the papillomavirus. In addition, three patients treated with conization had recurrence of lesions 1 year later. These results show that therapeutic vaccination with MVA E2 proved to be very effective in stimulating the immune system against papillomavirus, and in generating regression of high-grade lesion.
The content of endometrial receptors for estradiol (ER) and progesterone (PR) was determined in three groups (10 women each) classified with respect to body fat distribution: (1) normal, nonobese; (2) lower body segment obesity, and (3) upper body segment obesity. The ER in group 3 were significantly (p < 0.05) higher than those of group 1. As regards PR, no statistical differences were found among the three groups. These findings demonstrate different endometrial ER concentrations in obese women according to body fat distribution, greater in upper segment obesity. Probably the lack of progesterone as well as other factors in the endocrine milieu of these patients may determine the differences found; therefore, future research on this matter should be carried out.
The effect of clomiphene citrate (CC) on ovarian function in cycles subsequent to treatment withdrawal was studied. Thirty two out of 45 patients with anovulation due to polycystic ovarian syndrome (PCOS) and with no other factor affecting fertility who got pregnant were included. All patients received CC to induce ovulation. Pregnancies in CC treated cycles and after treatment were recorded. Twenty pregnancies were achieved during CC treated cycles and 12 in the cycles after it was withdrawn. In the latter group, eight pregnancies were achieved in the cycle following CC therapy, and four in the second subsequent cycle. In relation to pregnancy complications no significant statistical differences were found between the group of patients who became pregnant during the stimulation cycles and in the cycles after CC.
A cohort of 123 infertile couples was studied by life tables over a 30-month follow-up period to determine the influence on reproductive prognosis of clinical features, namely the women's age, previous gestational events, evolution time, and a number of conditioning infertility factors. The cumulative pregnancy rate (CPR) was 60% at 30 months. Women aged 32 years or less had a CPR of 65% and those over 32 years had a CPR of 31%. Couples with previous pregnancy had a CPR of 88%, while those with primary infertility had a CPR of 45% (marginal statistical difference). The group with infertility evolution of 36 months or less had a CPR of 75% and those with greater than 36 months infertility evolution had a CPR of 43% (p < .05). With one conditioning infertility factor a CPR of 75% was found, and with multiple factors a CPR of 47% (p < .05) was found. With these results a grading chart was created using all the analyzed criteria, determining the proportion of pregnancies per number of negative points obtained; at greater grades the proportion of pregnancy was reduced (p < .01). This report establishes the prognostic value of different variables observed in the evaluation of infertile men and women, and a simple procedure to calculate the probability to achieve pregnancy is proposed.
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