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In males 9—45yrs old, to prevent anal, oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58; genital warts caused by HPV types 6 and 11; and anal intraepithelial neoplasia AIN grades 1, 2, and 3 caused by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and Vaccination does not eliminate the necessity to undergo screening for cervical, vulvar, vaginal, anal, oropharyngeal and other head and neck cancers as recommended. Not for protection against disease from HPV types through exposure to sexual activity or diseases due to HPV types other than 6, 11, 16, 18, 31, 33, 45, 52, and May not protect all vaccine recipients. Give by IM inj in deltoid or upper thigh. Each dose is 0. Or, 9—45yrs: 3-dose regimen: give 1 st dose at elected date, 2 nd dose 2mos after the 1 st dose, and 3 rd dose 6mos after the 1 st dose. Monitor patients for 15mins after administration.

Transthyretin (TTR) Cardiac Amyloidosis

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Several types of amyloid can infiltrate the heart resulting in progressive diastolic and systolic dysfunction, congestive heart failure, and death. Treatment of cardiac amyloidosis is dictated by the amyloid type and degree of involvement. Consequently, early recognition and accurate classification are essential. The diagnosis of amyloidosis requires histologic identification of amyloid deposits.

Congo Red staining renders amyloid deposits salmon pink by light microscopy, and a characteristic apple green birefringence under polarized light conditions Figure 1. Additional immunohistochemical staining for precursor proteins identifies the type of amyloidosis Figure 2. Congo Red staining of myocardial tissue from a patient with amyloid cardiomyopathy. A Light microscopy, and B polarized light microscopy, X magnification. Endomyocardial biopsies were stained with antibodies to a kappa light-chain, b lambda lightchain, c Serum amyloid A, and d TTR amyloid.

Bright light micrographs at X magnification. Two types of amyloid commonly infiltrate the heart: a immunoglobulin light-chain AL or primary systemic amyloid, and b transthyretin TTR amyloid. Transthyretin-related amyloidoses, in turn, encompass two forms of disease — familial disease arising from misfolding of a mutated or variant transthyretin familial amyloid cardiomyopathy FAC or familial amyloidotic polyneuropathy FAP , and a sporadic, non-genetic disease due to misaggregation of wild-type transthyretin senile systemic amyloidosis SSA.

Cardiac amyloidosis can also be caused by other precursor proteins such as Apoliporotein A1, but the prevalence of disease is low and beyond the scope of this review.

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