Association of Human Papillomavirus Genotype 16 Viral Variant and Viral Load with Cervical High-grade Intraepithelial Lesions.

Human papillomavirus genotype 16 (HPV16) is by far the genotype most strongly associated with cervical cancer; viral variant and/or viral load of HPV16 could modulate this association. The objective was to determine the association between the viral variant and viral load of HPV16 and the presence of cervical high-grade lesions. This cross-sectional study included all women in whom HPV infection was found by cervical smear during routine gynecologic health checks. Women with single or multiple HPV16 infections (n = 176) were selected for viral variant and viral load analysis. Smear results were classified using the Bethesda system. HPV types were classified according to the International Agency for Research on Cancer. Odds ratios (OR) with their 95% confidence intervals (CI) were estimated by logistic regression, adjusted for age, immigrant status, and coinfection with other high-risk genotypes. No statistically significant associations were found regarding the detected viral variants. A viral load above the median (>1,367.79 copies/cell) was associated with a significant risk of high-grade epithelial lesion or carcinoma, after adjusting for age, immigrant status, coinfections, and viral variant: (adjusted OR 7.89; 95% CI: 2.75-22.68). This relationship showed a statistically significant dose-response pattern after categorizing by viral load tertiles: adjusted OR for a viral load greater than the third tertile was 17.23 (95% CI: 4.20-70.65), with adjusted linear P trend = 0.001. In patients infected with HPV16, viral load is associated with high-grade intraepithelial lesions or cervical carcinoma. This could be useful as prognostic biomarker of neoplastic progression and as screening for cervical cancer.

Prevalence of high-risk HPV genotypes, categorised by their quadrivalent and nine-valent HPV vaccination coverage, and the genotype association with high-grade lesions.

BACKGROUND: The new nine-valent vaccine against human papillomavirus (HPV) includes the four HPV genotypes (6, 11, 16, and 18) that are targeted by the older quadrivalent HPV vaccine, plus five additional oncogenic types (31, 33, 45, 52, and 58) remain significantly associated with high grade lesions. We aimed to determine the prevalence of high-risk HPV genotypes in unvaccinated subjects and the association of these genotypes with the incidence of high-grade lesions. We also assessed which, if either, of these two HPV vaccines could have prevented these cases. METHODS: This cross-sectional study, conducted from 4 January 2010 to 30 December 2011, was composed of 595 women attending the Hospital General Universitario de Elche (Spain) gynaecology department who were positively screened for opportunistic cervical cancer by pap smears and HPV detection during a routine gynaecological health check. The pap smear results were classified using the Bethesda system. HPV genotyping was performed with the Linear Array HPV genotyping test, and viruses were classified by the International Agency for Research on Cancer assessment of HPV carcinogenicity. Odds ratios (ORs) with their 95% confidence intervals (95% CI) were estimated by logistic regression, adjusting for age and immigrant status. The prevented fraction among those exposed (PFe-adjusted) was determined as a measure of impact. RESULTS: At least one of the additional five high-risk HPV genotypes present in the nine-valent HPV vaccine was detected in 20.5% of subjects. After excluding women with genotype 16 and/or 18 co-infection, high-risk genotypes (31, 33, 45, 52, and 58) were associated with a higher risk of intraepithelial lesion or malignancy: adjusted OR = 3.51 (95% CI, 1.29-9.56), PFe-adjusted = 0.72 (95% CI, 0.22-0.90). Genotypes that are still non-vaccine-targeted were detected in 17.98% of the women, but these were not significantly associated with high-grade lesions. CONCLUSION: The greater protection of the nine-valent HPV vaccine is likely to have a positive impact because, in the absence of genotype 16 or 18 infection, these five genotypes on their own remained significantly associated with high-grade lesions.

Cáncer de vulva y su tratamiento en Alicante, España (2000-2013) / Vulvar carcinoma and treatment (200-2013)

Introducción: en los últimos años se ha incrementado el número de carcinomas de vulva, sobre todo en pacientes menores de 50 años, asociado al incremento del número de casos de neoplasia vulvar intraepitelial. Objetivo: describir nuestra casuística de lesiones invasivas vulvares. Métodos: se realiza una revisión retrospectiva de todas las neoplasias de vulva atendidas en el servicio de Obstetricia y Ginecología del Hospital General Universitario de Elche, Alicante, España desde 2000 hasta 2013. Resultados: esta serie comprende 38 casos. El carcinoma epidermoide fue la neoplasia más frecuente (78,9 por ciento). La supervivencia fue del 65 por ciento al finalizar el segundo año. La edad, el estado ganglionar, la presencia de márgenes afectos y el estadio tumoral, fueron predictores estadísticamente significativos para la supervivencia global. Conclusiones: la afectación ganglionar es un factor pronóstico importante para la supervivencia global. La elección de una técnica quirúrgica más conservadora disminuye la estancia hospitalaria sin modificar las tasas de recidivas ni la supervivencia(AU)

Introduction: In recent years it the number of vulvar carcinomas has increased, especially in patients younger than 50, associated with the increase of number of cases of vulvar intraepithelial neoplasia. Objective: Describe our casuistic of vulvar neoplasia in the last 14 years and Determine prognostic variables for survival. Methods: Aretrospective review of all vulvar malignancies is conducted for those treated at Obstetrics and Gynecology Department of Elche University General Hospital, Alicante, Spain, from 2000 to 2013. Results: Our series included 38 patients. The most frequent neoplasm was squamous cell carcinoma (78.9 percent). Global survival at 2 years was 65 percent. Age, lymph node metastasis, involvement of resection margins and tumor stage, were statistically significant predictors for overall survival. Conclusions: Inguino-femoral lymph node status is an important prognostic factors for overall survival. Conservative surgery improves postoperative morbidity without modifying outcomes(AU)

Diagnóstico prenatal de la peritonitis meconial intraútero / Prenatal diagnosis in meconium peritonitis

La peritonitis meconial aparece solo en uno de cada 30.000 nacimientos. Existen una serie de marcadores ecográficos que nos permitirán realizar el diagnóstico, disminuyendo de este modo la alta morbimortalidad perinatal que presenta esta dolencia. Presentamos un caso de peritonitis meconial fetal diagnosticado intraútero (AU)

Meconium peritonitis develops in only one of every 30,000 live births. Diagnosis can be suspected prenatally, based on ultrasound findings, thus reducing the high morbidity and mortality caused by this entity. We present a case of meconium peritonitis that was diagnosed prenatally (AU)

Inserción velamentosa extrema de cordón umbilical, sin rotura de vasa previa / Velamentous insertion of the umbilical cord without rupture of vasa previa

La inserción velamentosa del cordón umbilical está presente en 1 de cada 100 embarazos, asociando situaciones que comprometen la evolución perinatal; por ello necesitamos un diagnóstico de esta situación, previo al parto, mediante cribado ecográfico, por lo menos en aquellos casos con riesgo de vasa previa, como embarazos múltiples o fecundación in vitro, placentas previas o de inserción bajas, para realizar una cesárea electiva. Presentamos un caso extremo de inserción velamentosa; la distribución vascular recuerda a una jaula de pájaro y, pese a ello, de modo sorprendente, no hubo lesión vascular (AU)

Velamentous insertion of the umbilical cord appears in one out of every 100 pregnancies and can prove life-threatening for the fetus. Consequently, prenatal diagnosis through ultrasound scanning is required, at least in women with a risk of vasa previa, such as those with multiple pregnancies, in vitro fertilization, or placenta previa, who will require an elective cesarean section. We present an extreme case of velamentous insertion of the umbilical cord, in which the vascular distribution was reminiscent of a bird's cage. Surprisingly, there was no vascular injury (AU)

Rotura uterina por placenta percreta. Un caso clínico en útero bicorne unicollis / Uterine rupture due to placenta percreta. A case in uterus bicornis unicollis

Se expone el caso de una gestante de 27 semanasde amenorrea, diagnosticada de útero bicorneunicollisy portadora de cerclaje cervical, queacude a urgencias por dolor abdominal. No seobserva dinámica. Tras empeoramiento general yprogresivo en 4 h, se retiró el cerclaje y se indicócesárea urgente por shock hipovolémico ysospecha de desprendimiento prematuro deplacenta normalmente inserta. En la laparotomíase observó hemoperitoneo 2 l, útero bicorne,acretismo placentario con perforación de 3 cmen fondo del hemiútero gestante. Nació un fetomujer vivo de 1.030 g, que evolucionósatisfactoriamente

A woman in the 27th week of gestation, with aprior diagnosis of uterus bicornis unicollis and acervical cerclage in situ, presented to theemergency department with severe abdominal pain.No uterine dynamics were observed. The patientrapidly deteriorated shortly after admission,warranting removal of the cervical cerclage andemergency cesarean section delivery with theworking diagnoses of hypovolemic shock andabruptio placentae. Laparotomy showed free bloodin the peritoneum (2 liters) as well as a placentaaccreta with a 3-cm perforation in the uterinefundus. A female infant, weighing 1030 g, wasdelivered and progressed satisfactorilyshockwav