No abstract

The natural history of squamous cancer of the uterine cervix resembles that of a sexually transmitted disease (Kessler II, 1976). Potential aetiological agents include the transforming members of the human papillomaviruses, in particular HPV types 16 and 18, since a high proportion of patients with cervical intraepithelial neoplasia (CIN) and invasive carcinoma of the cervix are infected with these HPV types (zur Hausen, 1987; Cornelisson et al., 1989). In contrast, the prevalence of HPV 16 based on rigorous polymerase chain reaction (PCR) studies in women with no evidence of cervical disease is between 5-17% (Van den Brule et al., Bavin et al., 1992). Complementary to the epidemiological investigations linking HPV 16 and cervical cancer, in vitro studies have shown that HPV 16 is capable of immortalising transformed cell lines through the E6 and E7 protein products binding to the cellular tumour suppressor genes p53 and plO5RB respectively (Dyson et al., 1989;. Recent data (Crook et al., 1992) have shown that in women with cervical carcinoma, mutations in p53 and the presence of HPV 16 or 18 DNA are mutually exclusive, thus confirming similar data obtained from analysis of established cervical cancer cell lines (Crook et al., 1991;.In addition to a possible role in the aetiology of cervical carcinoma, the presence of HPV 16 DNA may be of use as a prognostic marker of high-grade cervical disease, i.e. CIN 2 and CIN 3. Previous work in our laboratory (Bavin et al., 1992) has shown that the presence of HPV 16 DNA is useful in identifying women with high-grade cervical disease within a general practice population with an associated relative risk of 5.67. In addition, the combination of cytology and HPV 16 positivity identified more women with significant disease than either screening method alone. However, the clinical setting which would most benefit from a prognostic marker of high-grade cervical disease is in the large number of women referred for colposcopy with a smear suggesting mild dyskaryosis. We have previously shown (Giles et al., 1989) that approximately one third of these women will have high-grade disease whilst the remainder will have either CIN 1 or be colposcopically normal. A mechanism to differentiate women with high-grade disease within such a referral population would have a significant impact on targeting colposcopic resources to those individuals at high risk.Recent use of a semi-quantitative PCR method (Cuzick et al., 1992) has suggested that the presence of high or intermediate quantities of HPV 16 DNA in cervical scrapes is useful in identifying women with high-grade cervical disease within populations referred with a mild or moderately dyskaryotic smear. However, it should be noted that the data provided for the population referred with a mildly dyskaryotic smear contained relatively small numbers of women (23 in total). Therefore, we report here the qualitative and semi-quantitative PCR assessment of HPV 16 DNA in a population of 200 women referred with a smear suggesting mild dyskaryosi...

A prospective longitudinal study of 87 renal allograft recipients identified 31 patients with cytomegalovirus (CMV) viraemia. Previous studies have identified CMV viraemia, donor positivity, and CMV load in urine as independent risk factors for disease following renal transpl antation. We used quantitative-competitive polymerase chain reaction (QC-PCR) to quantify the CMV DNA load in blood from these patients, and report that it is a significant and independent risk factor for CMV disease. Patients with symptomatic CMV infection had significantly higher maximum CMV loads than those with no disease (P = .0003). We also found that peak loads were significantly higher in individuals experiencing primary CMV infection (P < .01), and CMV re-infection (P < .05) compared with recipients reactivating endogenous CMV. Univariate analysis revealed that CMV DNA load in blood, donor seropositivity, and receipt of antithymocyte globulin (ATG) were all significantly associated with disease (P = .005, .04, and .05, respectively). However, the association of donor/recipient serostatus, and receipt of ATG became nonsignificant in multivariate analyses whereas the significance of the quantity of CMV DNAemia was maintained, illustrating that CMV load plays a central role in the pathogenesis of CMV disease.

Twelve children with vertebrobasilar artery stroke are reported (seven males, five females; aged 6 months to 15 years). Patient 1 showed an arcuate foramen in the posterior arch of the atlas, an anatomical variant occurring in 3 to 15% of the population. It was hypothesized that the presence of the arcuate foramen might cause tethering of the vertebral artery and lead to its dissection by repetitive trauma. Lateral plain films of the cervical spine in cases of posterior circulation stroke were taken. Eight of 11 patients showed aberrant arcuate foramina. Of the remaining three patients, one had normal cervical spine X‐rays, one had an absent right posterior arch of the atlas following previous surgery for a cervical meningocele, and one patient had incomplete ossification of the vertebrae. Seven of the nine patients with arcuate foramina had vertebral angiograms. In all cases this showed the vertebral artery passing through the arcuate foramen before entering the brain and an appearance consistent with arterial dissection and occlusion at the same site below the foramen. Most documented cases of posterior circulation stroke in children follow trauma, which may be minimal or repetitive, with thrombotic occlusion of the artery at C1‐C2 level. The association with an arcuate foramen and its possible causative role in the genesis of posterior circulation stroke in children has not been previously recognized. There may be a causal association between the presence of an arcuate foramen, tethering of the vertebral artery in the foramen, and dissection from repetitive trauma with movement of the neck.

Twelve children with vertebrobasilar artery stroke are reported (seven males, five females; aged 6 months to 15 years). Patient 1 showed an arcuate foramen in the posterior arch of the atlas, an anatomical variant occurring in 3 to 15% of the population. It was hypothesized that the presence of the arcuate foramen might cause tethering of the vertebral artery and lead to its dissection by repetitive trauma. Lateral plain films of the cervical spine in cases of posterior circulation stroke were taken. Eight of 11 patients showed aberrant arcuate foramina. Of the remaining three patients, one had normal cervical spine X-rays, one had an absent right posterior arch of the atlas following previous surgery for a cervical meningocele, and one patient had incomplete ossification of the vertebrae. Seven of the nine patients with arcuate foramina had vertebral angiograms. In all cases this showed the vertebral artery passing through the arcuate foramen before entering the brain and an appearance consistent with arterial dissection and occlusion at the same site below the foramen. Most documented cases of posterior circulation stroke in children follow trauma, which may be minimal or repetitive, with thrombotic occlusion of the artery at C1-C2 level. The association with an arcuate foramen and its possible causative role in the genesis of posterior circulation stroke in children has not been previously recognized. There may be a causal association between the presence of an arcuate foramen, tethering of the vertebral artery in the foramen, and dissection from repetitive trauma with movement of the neck.