Acetic acid visualization of the cervix to detect cervical dysplasia

OBJECTIVE

To determine whether acetic acid visualization of the cervix can identify cervical dysplasia and improve detection of lesions missed by Papanicolaou test screening.

METHODS

During a 2-year period, patients attending family planning clinics for regular gynecologic examinations had acetic acid applied to the cervix, followed by gross visualization without magnification. Patients with suspicious acetowhite lesions and normal Papanicolaou tests were referred for colposcopic evaluation. Findings from these examinations and corresponding biopsy results were analyzed retrospectively.

RESULTS

Eighty-five women were referred for colposcopy because of abnormal acetowhite areas on the cervix. Thirteen patients (15%) had cervical intraepithelial neoplasia (CIN) (nine CIN I, four CIN II), 22 (26%) had koilocytosis, and 16 (19%) had benign histologic findings. In total, 51 patients had suspicious lesions at colposcopy for which biopsies were performed, and 34 (40%) had normal colposcopic examinations.

CONCLUSIONS

Acetic acid visualization of the cervix can detect dysplasia otherwise missed by Papanicolaou test screening. However, further refinements in technique are required to decrease false-positive findings and unnecessary referrals for colposcopy.

HIV roundtable. Professional perspectives

As the HIV epidemic escalates, concern is mounting over the implications of infection among health care workers. Should all medical professionals be tested? Should supervisors and/or patients be notified if the results are positive? Should the infected PA continue to practice? What about performing surgery? Should he or she be considered impaired? And what about the long-term stress of working with HIV patients? Experts discuss the AAPA's latest recommendations, and share suggestions on prevention and patient care with the audience.

HIV roundtable. Strategies to enhance professional awareness and involvement. Part II

Despite extensive public attention to the social and medical problems associated with HIV infection and AIDS, many clinicians remain largely uninvolved in public health and patient counseling programs aimed at preventing infection and getting patients into treatment. Suggestions to enhance professional involvement include improved schooling and continuing medical education; increased liaison and exchange of information among the various groups working with AIDS patients and at-risk populations; and programs to help clinicians confront their own feelings and concerns relating to AIDS.

HIV roundtable. Strategies to enhance professional awareness and involvement, Part I

Despite extensive public attention to the social and medical problems associated with HIV infection and AIDS, many clinicians remain largely uninvolved in public health and patient counseling programs aimed at preventing infection and getting patients into treatment. Suggestions to enhance professional involvement include improved schooling and continuing medical education; increased liaison and exchange of information among the various groups working with AIDS patients and at-risk populations; and programs to help clinicians confront their own feelings and concerns relating to AIDS.

A rat hybridoma model of Heymann nephritis: production of a monoclonal anti GP330 from a nephritic rat

Autologous (Heymann) nephritis was induced by immunizing Sprague-Dawley rats with a crude membrane extract (Fx1A) prepared from renal cortical tubules. Urine protein excretion was monitored to determine the onset of nephritis and then the spleens of nephritic rats were fused with a non-secretor rat myeloma cell line. Supernatants from hybridoma cultures were first screened for production of anti-brush border membrane (BBM) antibody by immunodot blotting of highly purified rat BBM on nitrocellulose. Positive hybrids were then tested by indirect immunofluorescence for the presence of IgG, which binds to the brush border of rat renal proximal tubules. Those hybrids which were positive by both screening assays were subcloned twice. Two monoclonal antibodies (C5, D11) were studied in some detail. Both C5 and D11 immunoprecipitated a single polypeptide from BBM, labelled with 125I by the lactoperoxidase method. Radioautography of gradient 4-11% slab sodium dodecyl sulphate polyacrylamide gels revealed that the polypeptide against which C5 and D11 were directed co-migrated with the polypeptide immunoprecipitated by (i) IgG eluted from the renal cortex of nephritic rats, and by (ii) a mouse anti-rat monoclonal against gp 330 [a BBM constituent with proven pathogenicity [9]]. Supernatants which tested positive by immunodot blotting but negative by indirect immunofluorescence showed no detectable immunoprecipitate after reaction with BBM. Immunocytochemical staining by immunoperoxidase and immunogold methods localized C5 and D11 to the BBM of the renal proximal tubule and to the urine face of the glomerular epithelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid endarterectomy under local anesthesia supplemented with neuroleptic analgesia

Surgical treatment of the carotid artery is being performed increasingly under local rather than general anesthesia. The advantage of local anesthesia is that neurologic function can be continuously assessed while the carotid arteries are cross-clamped, and unnecessary shunting can, thus, be avoided, with resulting sedation, analgesia, alpha blockade and blood pressure stability. The main objection to the use of local anesthesia is the anxiety of the patient. We overcame this difficulty in a series of 42 patients by supplementing the local anesthetic with neuroleptic analgesia. The possible disadvantages of neuroleptic administration are apnea and prolonged sedation. Only one of the patients we studied required an intraluminal shunt. One patient died of cardiac disease and one suffered an early postoperative stroke, which subsequently resolved. We believe that local anesthesia, supplemented by neuroleptic sedation and analgesia to overcome patient anxiety, should be more widely used for carotid endarterectomy.

PA impairment due to HIV infection. Part II: Building a professional support network. Forum

Several members of the AAPA's Lesbian and Gay Physician Assistants Caucus who participated in the roundtable PAs and HIV-Antibody Testing: The Need for Guidelines When the Practitioner Is at Risk (1989;13[5]:146-158) met with members of the 12-Step/Caduceus Caucus to begin developing a cooperative effort to assist PAs who test positive for antibodies to the human immunodeficiency virus, and to explore other HIV-associated impairment issues. Part II focuses on concerns of the provider who is HIV-antibody positive as well as ways PA groups can cooperate to raise the profession's conciousness further and recommend guidelines and policy.

Immunocytochemical characterization of cells in rat glomerular culture

Identification and characterization of cells in glomerular tissue culture has been an ongoing concern of experimental renal biologists. We examined the immunocytochemical staining profiles of primary and passaged rat glomerular cultures using a battery of commercially available antisera. In all culture systems examined, two distinct cell populations could be distinguished. One cell type stained positively for desmin and had ultrastructurally smooth muscle features typical of contractile mesangial cells. The second cell type proliferated in a manner classically described for "epithelial" cells but, intriguingly, did not express any of the numerous epithelial markers tested. The second cell population may represent an undifferentiated reserve cell type. Immunocytochemical methods offer an independent modality to the evaluation of cells which proliferate in glomerular cell culture.

PAs and HIV-antibody testing. The need for guidelines when the practitioner is at risk. Discussion

The PA profession should establish guidelines for PAs at risk for infection with the human immunodeficiency virus (HIV) who wish to be tested for HIV antibody. Confidentiality and anonymity are critical factors, along with the employer's established policies. PAs working in emergency and surgical settings may be at greater professional risk of exposure to HIV; those with personal risk factors may consider being tested if their work exposes them to opportunistic infections. A clearinghouse for information should be established through the American Academy of Physician Assistants and state chapters.

Biochemical investigation of the pathogenesis of Heymann nephritis

This study describes biochemical comparison of proximal tubule antigens from the brush border membrane (BBM) of dog and rat kidney. The purpose was to determine if a difference in BBM composition could explain the inability to produce either active or passive Heymann Nephritis in the dog. Although the membrane composition as revealed by coomassie blue staining on 4 to 11 per cent polyacrylamide electrophoresis varied considerably between rats and dogs, polyclonal antibodies (rabbit anti-rat, rabbit anti-dog) against purified BBM from both species immunoprecipitated five identical polypeptides. Four bands were visualized between 70 kd and 170 kd; but the major polypeptide had an apparent molecular wt of approximately 460 kd. This high molecular wt constituent and three of the other peptides were bound specifically to lentil lectin column, confirming their glycoprotein nature. Only the 460 kd polypeptide was immunoprecipitated by monoclonal antibody against gp 330. Since both rat and dog BBM contain gp 330, believed to be the sole pathogenic antigen in Heymann Nephritis, we conclude that failure to produce active or passive Heymann Nephritis in the dog using the same protocol that is successful in rats cannot be attributed to differences in antigenic make-up of the brush border membrane.

Congenital afibrinogenemia: an unusual case

We describe a congenitally afibrinogenemic young man who experienced massive spontaneous bleeding episodes at unusual sites, including the thigh muscles, lung and brain. Each of these life-threatening episodes raised theoretical and critical practical problems. A large local hematoma was responsible for an accelerated consumption of fibrinogen, which was relieved following evacuation. It is unusual for an afibrinogenemic patient to survive a number of potentially lethal bleeding episodes.

Biopsy proven evolution of post streptococcal glomerulonephritis to rapidly progressive glomerulonephritis of a post infectious type

A 15 year old boy with chronic impetigo was admitted with severe acute oliguric renal failure requiring temporary dialytic treatment. Renal biopsy revealed typical diffuse and proliferative glomerulonephritis of the poststreptococcal type. Subsequently high temperature developed with flank pains at the biopsy site, concomitantly with deterioration of renal function. On exploration, a sterile perirenal hematoma was found and a wedge renal biopsy revealed crescentic rapidly progressive glomerulonephritis of the post infectious type. Deterioration to end stage renal failure occurred within a few months. Although universally accepted, biopsy proven evolution from diffuse proliferative and exudative glomerulonephritis to crescentic form of post streptococcal glomerulonephritis has been rarely reported.

Spinal narcotics and central nervous system depression

A case of central nervous system depression which developed 7 hours after an intrathecal injection of 4 mg of morphine is described. The patient lapsed into coma with bradypnoea and "pin-point' pupils and there was no response to naloxone 0.4 mg. Treatment was continued for 3 hours. No postoperative analgesics were required for 126 hours. The problems associated with the use of intrathecal opiates are reviewed, delay in onset being the usual feature. Use of hyperbaric solutions of the narcotic and maintenance of a head-up posture may protect against respiratory depression.

Bradykinin, plasma protein fraction, and hypotension

A directive from the Food and Drug Administration indicates that the use of plasma protein fraction (PPF) is contraindicated during cardiopulmonary bypass because of possible hypotension. Bradykinin has been implicated as the cause of this hypotension. Bradykinin levels were measured by radioimmunoassay in PPF and in 5% albumin and were found to be consistently elevated in the former and occasionally in the latter. The addition of PPF to pump primes resulted in significantly elevated levels of bradykinin, which rapidly cleared, indicating that extrapulmonary sites of bradykinin inactivation were efficient. The potential hypotensive effect of PPF was observed by determining the change in mean perfusion pressure in two groups of patients: one group with a 3,000 ml crystalloid prime and the other with a prime of 2,000 ml of crystalloid and 1,000 ml of PPF. There was no significant difference in the perfusion pressure between the two groups at any point, and the hypotensive effects seen in both groups were readily treated, suggesting that the directive against the use of PPF during cardiopulmonary bypass may be unnecessarily restrictive.

Epidural morphine in treatment of pain

Epidural injections of a 2 mg morphine were given to 10 patients with severe acute or chronic pain. All cases had considerable amelioration of pain, which commenced within 2-3 min, reached a peak in 10-15 min, and was effective for 6-24 h. It is suggested that the morphine reached the subarachnoid space and produced its effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior-horn cells of the spinal cord.

[Liver cirrhosis in Israel (author's transl)]

The incidence of death caused by cirrhosis of the liver has increased in Israel during the last 20 years as it has in other parts of the world; still the incidence is much lower than in most countries. Increasing alcoholism and higher rates of hepatitis probably play a role, however in many cases the cause of cirrhosis remains in the dark.