Frequency of Chlamydia trachomatis infection in cervical intraepithelial lesions and the status of cytological p16/Ki-67 dual-staining

Background: Chlamydia trachomatis (Ct) is not a disease subject to mandatory reporting in Brazil, and the prevalence rate of this genital infection varies according to the region in which studies are conducted, as well as by the detection technique employed. Ct has been associated with persistence of Human papillomavirus (HPV) infection and the facilitation of cervical carcinoma development. We evaluated the Chlamydia trachomatis infection and its association with cytology, p16/Ki-67 dual-stained cytology and cervical intraepithelial lesions status in a screening cohort in Brazil. Methods: This was a cross-sectional study of 1481 cervical samples from asymptomatic women aged 18 to 64. Samples were collected for liquid-based cytology and Ct detection by polymerase chain reaction. p16/Ki-67 double staining was performed on samples with abnormal cytology. Statistical analysis was by chi-square and likelihood-ratio tests. Odds ratio (OR) and 95% confidence intervals (95% CI) were determined. Results: The frequency of Ct was 15.6% and its presence was not associated with detection of p16/Ki-67 [OR = 1. 35 (0.5-3.4)]. There was also no association between abnormal cervical cytology and Ct-positivity [OR = 1.21 (0.46-3.2)]. Associations were observed between p16/Ki-67 and high-grade lesions detected by cytology and in biopsies [OR = 3.55 (1.50-8.42) and OR = 19.00 (0.6-7.2), respectively]. Conclusions: The asymptomatic women in our study had a high frequency of Ct infection but this was not associated with p16/Ki-67 detection in samples with abnormal cytology. The expression of p16/Ki-67 was highest in women with high-grade CIN (p = 0.003).info:eu-repo/semantics/publishedVersio

Is preoperative embolization a prerequisite for spinal metastases surgical management?

SummaryBackgroundPreoperative embolization decreases the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular metastases such as renal cell carcinoma. There is no consensus concerning embolization in other metastases. The purpose of this study was to compare the intraoperative amount of blood loss in embolized versus non-embolized patients, seeking for differences depending on the primary tumor and the extent of surgery.Patients and methodsNinety-three patients, average age 60.5 years, were operated. The origins of metastases were: 28 breast cancer (30.1%), 19 pulmonary carcinoma (20.4%), 16 renal cell carcinoma (17.2%), 30 other cancers (32.3%). Surgical procedures were: 52 thoracolumbar laminectomies with instrumentation, 29 thoracolumbar corpectomies or vertebrectomies, 12 cervical corpectomies. A preoperative microsphere embolization was performed in 35 patients. Blood loss was evaluated by: blood volume in surgical aspiration devices, number of transfused packed red blood cells units and hemoglobin variation during surgery.ResultsRenal metastases were systematically embolized. In the breast group, there was no significant difference (P>0.05) in blood loss between embolization versus non-embolization. In the pulmonary group and in other metastases, no difference was found either. The extent of surgery (corpectomy/vertebrectomy versus thoracolumbar instrumentation and cervical corpectomy) increased bleeding: breast 1775ml versus 778ml and 600ml respectively (P=0.048), pulmonary 2500ml versus 430ml and 180ml (P=0.020), renal 3346ml versus 1175ml and 780ml (P=0.036) and others 1550ml versus 474ml and 400ml (P=0.020).ConclusionsEmbolization decreases the risk of hemorrhage in highly vascularized metastases such as renal cell carcinoma. A benefit of embolization was not found for metastases of breast or pulmonary tumors. As far as other metastases, thyroid carcinoma should be analyzed on a greater cohort. The extent of surgery remains an important risk factor for intraoperative bleeding. A preoperative angiogram should be carried out in all types of metastases prior to a thoracolumbar corpectomy or vertebrectomy to perform an embolization if the tumor is hypervascular.Level of evidenceLevel IV, retrospective study

Is preoperative embolization a prerequisite for spinal metastases surgical management?

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