Detection and typing of human papillomaviruses in cervical smears by an original application of the polymerase chain reaction.

The detection and typing of human papillomaviruses on cervical smears were performed by means of a new application of the polymerase chain reaction allowing easier and faster detection of the amplification product. This application consisted of a combination of two series of amplifications and the use of primers labelled with biotin and with 125 iodine on a reporter group for the second amplification. The final amplification product was detected by counting the radioactivity after incubation of the media in avidin-coated tubes. This test was compared with conventional methods of detection by electrophoresis and Southern blot and its specificity was confirmed. The study of a series of 52 patients demonstrated a higher prevalence of type 16 in relation to type 6/11 and 18 and a correlation between the degree of dysplasia and the frequency of oncogenic types 16 and 18. This new application could facilitate studies of the prevalence of HPV in large series of cervical smears.

[Peroperative colposcopic examination of conization tissue. Determination of the complete or incomplete nature of the cone]. / Colposcopie per-opératoire d'une pièce de conisation. Mise en évidence de son caractère complet ou incomplet.

The authors describe an original technique which makes it possible for them to determine during the operation whether conisation has been complete or incomplete. The tissue removed is examined during the operation colposcopically after it has been stained with an aqueous solution of toluidine colour blue. Pathological epithelium can be recognized easily and it is possible to measure the distance between the edge of this epithelium and the tissue that has been removed. If it is inadequate more can be cut out immediately. The distance should be at least 5 mm from the edge of the pathological epithelium.

[Comparative epidemiologic study of 120 patients with condylomatous lesions and 120 control patients]. / Etude épidémiologique comparative entre 120 patientes atteintes de lésion condylomateuse et 120 patientes témoins.

The authors compared 120 women who had condylomata with 120 controls. The patients were more frequently single or divorced than the controls. Age at first sexual intercourse was the same in the patients and in the controls, but the total number of sexual partners was higher in the patients than in the controls. The age at first pregnancy was 24 years in the patients and 28 in the controls. About equal numbers of genital infections were found in the history of the controls as in the patients. On the other hand some specific urogenital infections were more frequent in the patients. Chlamydia diagnosed by a positive level at 1/64 in the serum test occurred in 21.4 per cent of patients and 5.5 per cent of controls.

[Histological aspects of lesions of the cervix uteri correlated with different types of human papillomavirus]. / Aspects histologiques des lésions du col uterin correlés aux différents types de papillomavirus humains.

Cervical biopsies from 66 women presenting an abnormal smear, with HPV related features were studied and histologic features were correlated to the HPV type, as determined by molecular hybridisation studies. HPV DNA sequences were evidenced in 13 of 19 lesions corresponding to exophytic or flat condyloma (HPV type 16 in seven cases, HPV type 11 in four cases, as yet uncharacterized HPV types, HPV X, in two cases). Fourty biopsies were histologically interpreted as CIN, on the basis of atypical mitotic figures (AMF) and/or basal-parabasal cell atypia. HPV type 16 was evidenced in 20 cases (3 cases of double infection: HPV types 16 and 18, HPV types 16 and 33, HPV types 16 and X). In 10 other cases, HPV DNA sequences corresponding to HPV type 11 (one case), HPV 18 (one case) and HPV X (8 cases) were evidenced. In this study, potentially oncogenic HPV types (HPV 16, HPV 18, HPV 33) have been found only in CIN lesions defined on the presence of AMFs and/or basal-parabasal cells atypia. These histologic criteria seem to allow a distinction between low and high risk cervical lesions.

Management of 633 cervical intraepithelial neoplasias by CO2 laser: persistent diseases and recurrences.

During the past 6 years, we have managed 633 cervical intraepithelial neoplasias with the CO2 laser. If the lesion is located on the ectocervix, the CO2 laser is used to vaporize it under the microscope. If the lesion is located in the endocervical canal, the CO2 laser is used to excise a cylinder-shaped tissue with a handpiece. Colposcopic examination is performed 21 days after treatment. Persistent disease is recognized at this examination; healing is obtained spontaneously in 66% of those with persistent disease without second treatment. There were eight with recurrent disease with abnormal Pap tests and abnormal colposcopic findings, and 12 with recurrent disease with abnormal Pap tests and normal colposcopic findings (recurrent koilocytis cells). After laser treatment cervical function was good and pregnancies were normal.

[Analysis of a consecutive series of 421 cases of genital condylomata. Course, management and therapeutic results]. / Analyse d'une série continue de 421 condylomes génitaux. Evolution, conduite et résultats thérapeutiques.

The evolution of 421 cases of condylomata that have been followed seems to be less favourable than in other series in the literature. 45% of these cases became worse and 13% regressed, especially in the first year after diagnosis. Sometimes the case progresses in an atypical manner. It can be extremely rapid so that it becomes intra-epithelial carcinoma in less than a year in young patients who have not been pregnant or not had babies and who have cervical and vaginal infections and who use combined oral contraceptive pills. On the other hand it can "seesaw" with periods of worsening alternating with periods of regression. Treatment should be with local destruction using the CO2 laser if the lesion is on the exocervix or laser CO2 conisation if it is an endocervical lesion. It is important to distinguish when treatments have been incomplete. This involves some persistence of the lesion even after treatment, or recurrences which can be less or more serious than the initial lesion. 11% of the cases treated by local destruction showed that some of the lesion persisted after the treatment and that there were 13% of recurrences. After conisation on the other hand 8% of cases were shown to be incompletely treated and 3% showed recurrences.

[Analysis of a continuous series of 421 genital condylomata. Epidemiology and diagnosis]. / Analyse d'une série continue de 421 condylomes génitaux. Epidémiologie et diagnostic.

421 patients who had genital condylomata were studied between 1979 and 1984. The majority of these patients were aged between 20 and 40 years and had had their first sexual intercourse at between 18 and 20 years of age. Most of them used oral contraception. They had had no children or one or more abortions. 10% of them had taken corticoids in the immediate period before reporting their condition. The diagnosis was made by colposcopic examination, by cytology and by histology. The diagnosis was suggested by colposcopy in two-thirds of the cases. Koilocytes were not found in about one third of the cases cytologically. Similarly koilocytic atypia was missing histologically in many cases. It is worth while looking for cellular hyperactivity. The definitive diagnosis is made when the virus is identified. This is essentially done by the hybridation test in D.N.A.

[Treatment of cervical and vulvar condylomata by co2 laser also with a immunostimulant]. / Traitement des condylomes cervicaux et vulvaires par laser CO2 associé à un immunostimulant.

Condylomata are of viral origin and are found in increasing frequency. The CO2 laser has contributed significantly to the treatment of this condition with a failure rate approximating 35 p. cent of cases. Two groups of patients with cervical or vulvovaginal condylomata were treated by CO2 laser or by CO2 laser and Isoprinosine. After the initial treatment, there were 31,6 p. cent failures in the group treated only by CO2 laser in patients with cervical condylomata, and 66,3 p. cent failures in those with vulvovaginal condylomata. Following 3 laser treatments, there was a 5,3 p. cent failure rate with the cervical condylomata, and 33,3 p. cent with the vulvovaginal condylomata. In the group treated by CO2 laser and Isoprinosine, there were 6,9 p. cent failures in patients with cervical condylomata and 5,7 p. cent failures in those with vulvovaginal condylomata following the initial treatment. After 3 treatments there were no failures. The combined use of CO2 laser and Isoprinosine reduces significantly the number of recurring condyloma acuminata, and appears to us to be an effective form of treatment.

[Distal tubal microsurgery using the CO2 laser. Experimental study and analysis of a series of 95 cases]. / La microchirurgie tubaire distale au laser CO2. Etude expérimentale et analyse d'une série de 95 cas.

After having used the CO2 laser in gynaecological surgery for 5 years, can we already work out a balance of the effects of laser in this field and especially in tubal microsurgery? An experimental study was carried out on 2 groups of rabbits, the first group being one where artificially created adhesions were freed without any residue thanks to the CO2 laser, and a second group where the uterine cornua could be sutured using pulses of laser and no sutures. 95 microsurgical tubal operations were carried out using the CO2 laser between 1979 and 1983. Adhesiolysis was carried out in 39 patients with 25 intra-uterine and one extra-uterine pregnancies resulting. Fimbrioplasty was carried out in 41 patients with 24 intra-uterine and 2 extra-uterine pregnancies. Salpingostomy was carried out in 15 patients with 5 intra-uterine pregnancies and one extra-uterine pregnancy. A second surgical procedure was carried out in 20 patients with 7 intra-uterine pregnancies and one extra-uterine pregnancy. The CO2 laser makes microsurgical techniques easier and avoids recurrent adhesions, giving rise to a level of pregnancies in the region of 60% after adhesiolysis and fimbrioplasty. This latter term was used for the reconstruction of the ampulla, which had only partially been blocked. On the other hand, when there is a hydrosalpinx with total loss of patency, the laser is no more successful than classical microsurgical techniques.

[Five years' use of CO2 laser in the treatment of cervical lesions: 475 treated cases (mainly dysplasias and carcinomas in situ)]. / Cinq ans d'utilisation du laser CO2 dans le traitement des lésions cervicales: 475 cas traités (dysplasies et carcinomes in situ essentiellement).

The authors have used the CO2 laser for the treatment of cervical lesions since 1979. 475 cases were treated, of whom three-quarters were suffering from dysplasia or carcinoma in situ. The cases were discovered by smears from the cervix and vagina and by colposcopy and were confirmed by biopsy. The ways in which the treatment could be conducted depended on the site and not on the severity of the lesion so long as cases of micro-invasion were excluded. When the lesion was sited on the ectocervix the treatment consisted, after taking a small biopsy for histological checking, in the destruction of the lesion using a laser attached to a microscope. When the lesion was endocervical conisation had to be carried out using a laser attached to an apparatus held in the hand. Colposcopic examination carried out 15 to 20 days after treatment made it possible to discover whether the treatment had been complete or not. Recurrences are characterised by the return of colposcopic and cytological abnormalities. Sometimes these are only cytological and may occur 6 to 18 months after treatment. After 5 years the level of recurrences is remarkably low and is less than 4 per cent. Secondary complications such as haemorrhage are very rare, and the morphology of the cervix is hardly changed except in a few cases. The operator must know very well indeed how to use the colposcope to undertake such treatments successfully,

[Carbon dioxide laser in the treatment of premalignant lesions of the cervix (author's transl)]. / Le laser dans le traitement des lésions précancéreuses du col utérin.

Cervical dysplasia is classified in various groups according to the extent of the epithelial anomalies. Severe dysplasia, in which the entire depth of the epithelium is diseased, is assimilated to the situ carcinoma. The diagnosis is established by cytology and above all by colposcopy which enables to guide the biopsy. Since all dysplasias, whether mild, moderate or severe, may lead to cancer, their treatment is always warranted. The carbon dioxide laser appears to be superior to the other methods of local therapy. Exocervical dysplasia requires ablation for histological examination, followed by a 7 mm-deep tissue destruction. The carbon dioxide laser also allows conization for endocervical dysplasias. A perfect knowledge of colposcopy is indispensable for this therapeutic procedure.

[Conical amputation of the cervix with CO2 laser (author's transl)]. / Evidement conoïde du col avec le laser CO2.

Conical amputation of the cervix is performed to treat intra-epithelial carcinomas of the cervix and endocervical dysplasias. The width and length of the cone can be adapted to the extent of exo- and endocervical lesions. The two main drawbacks of the operation are immediate or delayed haemorrhages and inability to watch the borderline between squamous and cylindrical epithelia, which is no longer visible. These drawbacks are not avoided with the usual technique using invaginating Sturmdorf sutures, whereas conical amputation with a CO2 laser coupled with a hand-piece rather than with a microscope provides virtually bloodless sections and rapid healing, within 3 weeks, without eschar detachment. In addition, there is no risk of secondary stenosis, and the squamous/cylindrical junction remains visible and can be examined by colposcopy, cervicovaginal smears and biopsies.

[Induction of labour using interrupted transfusions of posterior pituitary hormone. A study in uterine contractility (author's transl)]. / Déclenchement du travail par perfusion discontinue de post-hypophyse. Etude de la contractilité.

We have tried to induce labour using interrupted infusions of oxytocin in order to try to mimic the physiological spurts that occur in the secretion of circulating oxytocin. Uterine contractions are quite different from those found in the usual form of induction of labour. Induction in this way resulted in dilatation of the cervix and vaginal delivery in the 100 cases we have studied. It seemed to us that with the absence of an intra-uterine catheter induction could be successful without rupturing the membranes.

[Cervical dysplasia and their treatment with the CO2 laser (author's transl)]. / Les dysplasies cervicales et leur traitement par le laser CO2.

The authors expound on their protocol for the treatment of dysplasias using the CO2 laser after they have reviewed the classification of dysplasia which is at the present time undergoing a lot of controversy. The indication for treatment is basal essentially on the site of the dysplasia in relationship to the endocervical canal. An exocervical lesion call for CO2 treatment with removal of a piece for histological examination and an endocervical lesion equally calls fro conisation carried out with the CO2 laser. A study of the post-operative appearances shows that clinically, colposcopically, cytologically and histologically, scar formation is perfect in 3 weeks due to centripetal metaplasia without spread from the zone of junction. It is essential to understand colposcopy perfectly before starting this from of treatment.

[A study of uterine contractility in the onset of labour (author's transl)]. / Etude de la contractilité utérine dans le déclenchement du travail.

We have studied uterine contractility in 100 inductions of labour at term. We have been able to compare the effects of oxytocic infusions with rupture of the membranes on contractility. Oxytocic infusions and rupture of the membranes seem to have similar effects on the amplitude as well as on the contractile surface and these effects are quantitatively reinforced by one another.

[The different elements constituting the Bishop score in the induction of labour with epidural analgesia (author's transl)]. / Les différents éléments du score de Bishop dans le déclenchement du travail aved analgésie péridurale.

We have collected together the Bishop scoring factors in 100 inductions of labour at term. The length of labour does not seem to be related to the height of the presenting part at induction. On the other hand, the consistence and degree of dilatation of the cervix do have each a prognostic value which is comparable to that of the total Bishop score. Furthermore, the score, while it is didactically useful, does seem to have some theoretical drawbacks.

[The diagnostic value of petrous bones in the fetal scalp (author's transl)]. / Valeur diagnostique et pronostique de l'orientation radiologique des rochers du crâne foetal.

We studied the orientation of the petrous bones in the fetal scalp in 200 X-ray pelvimetries. It is easy to measure the petrous bones' orientation when the fetal scalp is studied with Thoms view. It is possible to measure the height of the head in the pelvis in the lateral view. We have been able to measure asynclitism in flexion using a calculating machine. It seems to us that these findings are useful for the practical conduct of labour and can be of helpful prognostic value.