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09943cam a2200505 i 4500 |
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20070917173741.0 |
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|9 (HR-ZaNSK)228303
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|9 (HR-ZaNSK)990118002
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|a (HR-ZaNSK)000228061
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|a 618.146-006-07
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|a Grubišić, Goran,
|c liječnik
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|a Korelacija kolposkopskih slika s histološkim promjenama epitela vrata maternice zaraženog humanim Papillomavirusom (HPV) :
|b doktorska disertacija /
|c Goran Grubišić.
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| 260 |
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|a Zagreb :
|b G. Grubišić,
|c 1997
|e ([s. l. :
|f s. n.])
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| 300 |
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|a 120 listova, [7] table, [36] ilustr. ;
|c 30 cm.
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| 500 |
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|a Mentori: Duško Kanajet i Ahmed Pirkić
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|a Sveučilište u Zagrebu, Stomatološki fakultet, Zagreb, 1997
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|a Bibliografija: str. 109-116
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|a Summary
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|a Sažetak: N atemelju kliničkog opažanja i uvida u dostupnu literaturu (45-49, 66-68) želio sam u svojoj disertaciji usporediti kolposkopske slike i patohistološke dijagnoze kod bolesnica s HIV infekcijom vrata maternice sa ili bez popratne cervikalne intraepitelne neoplazije. Obradio sam ispitivanu (N=136 bolesnica) i kontroliranu skupinu (N=156 bolesnica). U cilju kompleksnijeg razumijevanja problematike dodatno sam obradio odnose između primijenjenih operativnih zahvata i patohistološke dijagnoze (ispitivana skupina N=126, kontrolirana N=156), te kolposkopskih slika i citoloških nalaza (ispitivana skupina N=133, kontrolna N=391). Statistička vjerodostojnost je izračunata primjenom x2 testa uz p[0,05.
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|a Iz usporedbe kolposkopskih slika i patohistoloških dijagnoza je uočljivo da su mozaik (x2=19,7898, p[0,0001, koef. konting.=0,2871) i acetobijeli epitel (x2=12,6930; p[0,0004; koef.konting.=0,2409) zastupljeniji u žena s HPV infekcijom, dok su atipične krvne žile podjednako zastupljene kod žena sa ili bez HPV infekcije (x2=2,2606; p[0,1327; koef. konting.=0,1090. Iz odnosa primjenjene operacije i patohistološke dijagnoze uočljivo je da su kod žena s HPV infekcijom vjerodostojno češće izvršeni poštedniji zahvati, tj. excochleatio canalis cervicis et excisio probatoria (x2=14,7648; p[0,0001; koef. konting.=0,2326) i excisio probatoria (x2=30,5662; p[0,0001; koef. konting.=0,3252), a konizacija vjerodostojno češće u žena bez HPV, ali s CIN jačeg stupnja (x2=73,3238, p[0,0001; koef. konting.=0,4594).
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|a Iz odnosa kolposkopske i citološke klasifikacije uočljivo je da su mozaik (x2=20,4206; p[0,0001; koef. konting.= 0,1980) i acetobijeli (x2=22,1212; p[0,0001; koef. konting.=0,2102) zastupljeni kod žena s HPV, kao i udružen nalaz PAPA III B i kolposkopske slike mozaika (x2=23,7858; p[0,0001; koef. konting.=0,2137) te udružen nalaz PAPA III A i kolposkopske slike acetobijelog epitela 8x2= 14,1127; p[0,0002, koef. konting.=0,1742). Postoji statistički vjerodostojna razlika u učestalost citoloških nalaza u žena s HPV pregledanima retro- i prospektivno (x2= 7,3693; p[0,0251) s tim da su nalazi PAPA II, III i IIIA učestaliji u prospektivnoj skupini, a III B i IV u retrospektivnoj skupini. Znači da smo intrvenirali i kod citološki blažih nalaza poštujući uhodan protokol: abnormalni citološki nalaz-kolposkopija-mala biopsija-definitivno liječenje.
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|a Iz navedenih podataka proizlaze preporuke za svakodnevni rad, a to znači da pri kolposkopiji moramo, kod slika koje smo naveli, mislili i na moguću prisutnost HPV infekcije pokrovnog epitela vrata maternice. Ukoliko je prisutna jaka citološka atipija, preporučam, posebno kod mladih, mikrobiološki obraditi cerviks, u indiciranim slučajevima liječiti upalu, ponoviti kontrolu obrisaka i citološki razmaz. Ako traje abnormalnost i ukazuje na prisutnost HPV-a, tada izvršiti HPV tipizaciju i, ovisno o prisutnom tipu virusa, planirati daljnje liječenje. S oobzirom da je kod najvećeg broja neoplazija težeg stupnja prisutan HPV 16/18 tip, to je kod mladih žena metoda izbora poštedna ablacija lezije, do momenta pronalaska odgovarajućeg cjepiva.
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|a Prevencija mora sadržavati seksualnu izobrazbu već u adolescentnim godinama, primjenu barijernih metoda kontracepcije te redukciju promiskuitetnih veza i ponašanja na najmanju moguću mjeru. Kad je infekcija već otkrivena, potreban je pregled i žene i njenog partnera. U slučajevima kada je potrebna daljnja obrada nakon histološkog probira, istu se može najbolje provesti u kliničkoj jedinici za displazije, u kojoj se nakon kolposkopije - te u indiciranim slučajevima ciljane biopsije - planira definitivno, što poštenije liječenje, pohrana podataka u suvremeni software-ing, te osigurava redovita kontrola i praćenje.
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|a Ukoliko je potrebna dodatna konzultacija, može se suvremenim pristupom telekomunikacijskom sustavu konzultirati eksperte iz područja kolposkopije u nama bliskim centrima kako u Hrvatskoj, tako i svijetu(194,195) (Italija, Austrija, Njemačka, Francuska).
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|a Summary: Due to clinical observation as well as to insight into contemporary bibliographic data, in my disertation I wanted to compare the colposcopic patterns and pothohistological diagnoses in patient with HPV infection of the uterine cervix with or without accompanying squamous intraepithelial lesion. Analysis includes tested (N=135) and control group (N=156). For better understanding of the problem I additionally analysed relations between operative methods and patohistological diagnoses (tested N=126, control N=156) aswell as colposcopic patterns and cytologic findings (tested N=133, control N=391).
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|a Comparing colpocopic patterns and patohistologic diagnoses in the first group it is obvious that mosaic (x2=19,7898; p[0,0001; conting.coef.=0,2871) and acetowhite epithelium (x2=12,6930; p[0,0004; conting. coef.=0,2409) are the most present patterns in women with HPV infection of the uterine cervix, whilst atypical vessels were equally found in women with and without HPV infection (x2=2,606; p[0,1327; conting. coef.=0,1090).
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|a Comparing operations and patohistological diagnoses it is clear that in women with HPV infections slighter operative methods were performed (endocervica curettage and punch biopsy x2=14,7648, p[0,0001, conting. coef.=0,2326, and punch biopsy x2=30,5662, p[0,0001, conting. coef.=0,3252) while cervical conisation was performed significantly more in women with higher grades of cervical neoplasia in control group (x2=73,3238; p[0,0001; conting. coef.=0,4594).
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| 520 |
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|a Analysing relations between colposcopy and cytologic findings it is obvious that mosaic (x2=20,4206; p[0,0001; conting. coef.=0,1980) and acetowhite epitelium (x2=22,1212; p[0,0001; conting. coef.=0,2101) were significantly present in women with HPV as well as conjoined findings with PAPA IIIB and mosaic (x2= 23,7858; p[0,0001; conting. coef.=0,2137) and PAPA IIIA and acetowhite epitelium (x2=14,1127, p[0,0002 conting coef.=0,1742). There was statistically significant difference in the incidence of cytologic findings in women with HPV infection examined retro- and prospectively (x2=67,3693; p[0,0251) with the point that PAPA II, III and IIIA were found more often in prospectively analysed group, and IIIB and IV in retrospective group.
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| 520 |
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|a It may be due to our intervention in cytologically slighter findings, having in mind usually performed protocol: abnormal cytologic smear-colposcopy-punch biopsy with or without endocervical curettage-and definitive treatment. Due to gynecologic practical approach it is obvious that colposcopic patterns of mosaic and acetowhite epitelium and, in lesserdegree, atypical blood vessels can be atributed not only to the presence of the HPV infection of the uterine cervix, but also to cervical neoplasia. In case of the higher degree of cervical epithelial atypia we recommend, especially in younger women, microbiological and in selected cases virological examination of the uterine cervix followed by target therapy and control.
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| 520 |
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|a In the cases with persistent cytological abnormality suspected to the presence of the HPV infection we suggest to perform HPV typisation.Depending on the detected HPV type we plan further treatment. From the recent data it is obvious that in the greatest percentage of cervical atypias HPV 16/18 type was present in infected epithelial layer of the uterine cervix with or without accompaying epithelial neoplasia, so that in younger women we must chose more conservative approach in the therapy of the cervical lesion till the moment when suitable vaccine will be discovered.
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| 520 |
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|a Prevention must consist of sexual education of both boys and girls alredy in adolescent years, application of barrier contraceptive methods in sexuallty active teenagers, and reduction as much as possible of sexual promiscuity which was supported to be one of the most imporatant factors in the spreading of the HPV infections in young population. Once the infection was diagnosed it is necessary to examine the woman as well as her partner. In patients who need further examination the same is best performed in dysplasia clinical unit which enables adequate treatment, softwareing and planing of skillful follow up. In the cases which need additional counselling the same can be archieved by modern telecommunication so that we can contact expert colposcopists both in our homeland and in our neighbourhood to (Italy, Austria,Germany, France).
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| 650 |
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7 |
|a Vrat maternice
|x Karcinom
|x Kolposkopija
|2 nskps
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| 700 |
1 |
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|a Kanajet, Duško
|4 cns
|
| 700 |
1 |
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|a Pirkić, Ahmed
|4 cns
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| 981 |
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|p CRO
|r HRB1997
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| 998 |
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|n DCD/97
|c sbno9901
|c dkrp9904
|c meri040614
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| 852 |
4 |
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|j DCD-ZG-12/98
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| 876 |
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|e DCD
|a 12/1998
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| 886 |
0 |
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|2 unimarc
|b 09649iam0 2200433 450
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