Determination of HPV type 16 and 18 viral load in cervical smears of women referred to colposcopy.

It has been recognized that human papillomavirus infection is the major causal factor for high-grade cervical lesions. The aim of the study was to evaluate the relationship between HPV 16 and 18 viral loads and cervical status in different age strata. A duplex real time PCR method was devised to determine HPV 16 and 18 viral load per million of human cells using an in house plasmidic construct as a standard of quantification. The 151 cervical scrapes were collected before colposcopic examination from either abnormal cervico-vaginal smear (group 1, 97 patients) or from post treatment clinical follow-up (group 2, 54 patients). In women aged 30-40, the HPV16 viral loads were significantly higher in high-grade squamous intraepithelial lesion than in low-grade squamous intraepithelial lesion in both groups and HPV18 in group 1. In women aged 20-30 of group 1, high HPV viral load was associated in few cases with high-grade squamous intraepithelial lesion or low-grade squamous intraepithelial lesion, and surprisingly in some patients with normal cervix. HPV 16 and 18 viral loads are related to the severity of cervical lesion, and may be useful in the clinical management of cervical lesions. A specific follow-up may be useful for those with high viral load despite normal cervix.

Experience in Managing 73 Patients with Positive Margins after Cervical Conization / 上海第二医科大学学报

ObjectiveTo study the proper treatment of the patient with positive margins after cervical conization. MethodsA total of 220 cervical conizations were performed in the department of obstetrics and gynecology in Conception Hospital in Marseille in France from January 1, 1996 to June 30, 1998. Among them, we studied 73 patients, who had positive margins, by using cervical cytology examination and colposcopy in 3,6,12,18 and 24 months after cervical conization. Results7 cases of cancer invasive were treated with radiotherapy; 17 underwent a second conization or hysterectomy, among whom 8 had residual disease of positive margins near internal orifice of uterus (residual rate, 47. 06 ％ ); 40 remained follow- up; but 9 were lost.ConclusionCytology and colposcopy are effec- tive in the surveillance of patients with positive margins after cervical conization, and can give the indica- tion of the second conization.

[Conization with positive margins: what strategy should be adopted?]. / Conisations non in sano: quelle attitude adopter?

OBJECTIVE: To define recommended treatment in cases of positive margins on cone biopsy specimens. PATIENTS AND METHODS: This single-center retrospective study concerned 220 conizations performed between January 1996 and June 1998. The results of 70 conizations (31.8%) with positive margins were analysed. There were 32 cold knife conizations (mean age: 43 years) and 38 conizations by the loop electrosurgical excision procedure (mean age: 33 years). RESULTS: Mean depth of conization was 15.94 mm for cold knife conization and 10.08 mm for loop electrosurgical conization. Fifteen patients were excluded (5 with invasive cancer and 10 were lost to follow-up). This study included 55 patients with a mean 12-month follow-up. Six underwent hysterectomy for mini-invasion on the specimen or advanced age. Eleven underwent a second conization (followed by hysterectomy in 2 cases). The other 38 patients were submitted to simple surveillance with cervico-vaginal cytology and colposcopic examination. The rate of residual lesions (cervical intra-epithelial neoplasia: CIN 3) after conization with positive margin was 14.5% (n = 8). CONCLUSION: Residual persistent dysplasia is not present in all patients after conization with positive margins. Cytology and colposcopy allow detection of dysplasia, indicating the need for a second conization. In women with no desire for further pregnancy, systematic repeat surgery must be recommended.

[Demand for abortion. Detection of cervical cancer and precancerous lesions]. / La demande d'avortement. Dépistage du cancer du col et des lésions précancéreuses.

PIP: Eighteen years of experience with cervical screening in the Center for Social Gynecology in Marseilles has demonstrated the existence of a group at high risk of cervical dysplasia. Its characteristics are early initiation of sexual activity, sexually transmitted disease, sexual promiscuity, and an unfavorable socioeconomic environment. Precancerous lesions are sometimes observed before the age of 18. Pap tests are done during preabortion consultations at the Center except in very young patients, those who are too emotionally distressed, and those with inflammations from vaginitis. The test may be done before the abortion because in the first trimester the cells do not yet show changes that would interfere with interpretation of the Pap smear. Bleeding after the abortion interferes with reading the slide. Results of 405 Pap tests conducted during a reference period from August 1992 to July 1993 among women seeking abortions at the Center for Social Gynecology were compared to those of 1601 women undergoing gynecological examinations at two other centers. Among patients at the Center for Social Gynecology and the other two centers respectively, 3.5% and 1.4% were diagnosed with condylomas, 1.5% and 1.2% with dysplasia, and 1.25% and 0.5% with condylomas and dysplasia. During the reference period, only 20% of women were screened. The number of lesions detected suggests that a higher proportion of women should be screened in this population of women often lacking regular medical care.^ieng

[Four years of screening cervical smears of cervical lesions]. / Quatre années de dépistage sur frottis cervical des lésions du col utérin.

Twelve thousand two hundred and eighty nine Pap smears were collected from public hospitals and from private practices during a four year period (January 1987 to December 1990). 4.2% of Pap smears exhibited condylomatous or dysplastic lesions. 94.5% of such lesions were encountered in Pap smears taken from the transformation zone and which contained endocervical cells. Therefore, these smears represent the only adequate sample for cervical cancer screening. In our study, a close concertation between biologists and clinicians results in an improvement of the smear quality. The percentage of those containing endocervical cells increased from 49% in 1987 to 72% in 1990. Then, more cervical lesions were encountered on smears of patients from a low socio-economic level. New techniques such as detection of human papillomavirus (HPV) DNA on routine Pap smears by in situ hybridization would allow to improve the cytological diagnosis of HPV infections, mainly for non specific cytological alterations (11% in our series for 1990) and for cytological aspects of dysplasia only. These results point out how a cervical cancer screening can be better carried out.

[Cervical screening and surveillance of the cervix uteri before the age of 20]. / Dépistage cervical et surveillance du col avant vingt ans.

The authors record a sample of 2,234 adolescents who were aged 20 years or less and who had systematic cervical screening. This was carried out in a Social Service gynaecological department and the reason for it was mainly to research in the epidemiology. The authors have analysed the results of 870 cervical smears and 62 colposcopies. They found that in this young population there were 11% dysplastic smears; 59% viral type smears (condylomata or herpes); 11% mild or moderate dysplasias and 16% flat condylomata that were proven histologically. The authors review the recent literature and their results and the risk factors for cancer of the cervix in adolescents and demonstrate the value of early screening of this population.

[1960-1980: the resistance to contraception]. / 1960-1980: les resistences a la contraception.

PIP: Resistance to contraception, especially when badly needed, has profound psychological roots, very often unclear. The unconscious desire for a child, vis-a-vis the conscious knowledge of the problems such a child may create, plays a fundamental role in the emotional life of a woman. Men can complicate the problem; they often identify sexual potency with reproductive power, and refuse contraception for their female partners. The role of a physician in such situations is very important, very difficult and delicate. He is the one who knows, who advises, who prescribes, and who must, above all, understand. Information on contraception should be more widespread and more accurate, and every young couple should be convinced that contraception will help resolve many demographic problems, create a more responsible sexuality, improve the affective and economic situation of a family, and diminish maternal and perinatal morbidity.^ieng

[The narrow path]. / La voie etroite.

PIP: This short paper attempts an evaluation, 4 years after the promulgation of the law, of legally induced abortion as practiced in the several Centers of Social Gynecology, in Marseille, France. The four basic principles of the law have been respected and realized: 1) availability of personnel, of hospital beds, and of clinics; 2) promotion of contraception and of health education; 3) organization of structures by which a woman can be advised and counseled while keeping total freedom of choice; and 4) unconditional respect of the clause of conscientious objection required by law. Problems still to be solved regard: 1) foreigners, especially from North Africa, who come to France to obtain an abortion; 2) minors without parents' consent; and 3) reimbursement of expenses by the Social Security.^ieng