[The concept of supersensitivity psychosis. The particular case of clozapine]. / Notion de psychose d'hypersensibilité. Cas particulier de la clozapine.

Neuroleptics are the main biological treatment for psychotic patients. The brutal withdrawal of a neuroleptic treatment may induce an important aggravation of the psychotic symptoms. A few of those relapses may occur very early after the interruption of treatment; they are often associated with a modification of the symptoms and an unfavorable evolution in the course of the illness. Using those clinical observations a few authors have developed the concept of supersensitivity psychosis to explain those kinds of relapses and to formulate hypothesis about tolerance and resistance to neuroleptics. They focus on the possible correlation between supersensitivity psychosis and tardive dyskinesia. We report three cases of a dramatic aggravation of the psychotic symptomatology following the withdrawal of clozapine in three schizophrenic patients resistant to classical neuroleptic treatment. According to the clinical data and to the physiopathological hypothesis, the concept of supersensitivity psychosis can have implications in the therapeutic management of resistant schizophrenic patients.

Risk factors for cervical intraepithelial neoplasia: differences between low- and high-grade lesions.

This case-control study assesses relations of human papillomavirus (HPV) type 16 infection, sexual history, cigarette smoking, and oral contraceptive use to low- and high-grade cervical intraepithelial neoplasia (CIN). A total of 548 high-grade and 338 low-grade CIN cases and 612 controls were identified among women seen at a colposcopy clinic in Quebec, Quebec, Canada, in 1988-1989. Interviews, colposcopy, cervical scrapings, and colposcopically directed biopsies were performed. One pathologist reviewed all histologic slides. Southern blot techniques were used to assay specimens for HPV 16 DNA. Lifetime number of sexual partners was related to low- and high-grade CIN. Presence of HPV 16 DNA was associated with a 8.7-fold (95% confidence interval 5.1-15.0) elevation in estimated relative risk of high-grade CIN. Relative risk of high-grade CIN increased with amount of HPV 16 DNA (p < 0.0001). Estimated relative risk of high-grade CIN in current cigarette smokers was 2.4 (95% confidence interval 1.8-3.2) compared with never smokers and increased with number of pack-years of exposure (p < 0.0001). Long-term (6 years or more) users of oral contraceptives had an estimated relative risk of high-grade CIN of 1.9 (95% confidence interval 1.1-3.3) compared with those who never used such contraceptives. In contrast, presence of HPV 16 DNA, cigarette smoking, and oral contraceptive use showed little or no relation to low-grade CIN. Risk factors for low- and high-grade CIN may differ substantially.

[Prognostic value of the cellular expression of carcinoembryonic antigen (CEA) in gastric adenocarcinoma]. / Valeur pronostique de l'expression cellulaire de l'antigène carcinoembryonnaire (ACE) dans les adénocarcinomes gastriques.

Fifty resected gastric adenocarcinomas were studied retrospectively to evaluate survival factors. Eleven different criteria were assessed using multivariate analysis. Only two criteria were significant: 1--cellular expression of carcinoembryonic antigen (p less than 0.0001 - CCR = 1.48) 2--intravascular or lymphatic tumor emboli (p less than 0.006 - CCR = 2.06). Thus, it is suggested that in addition to the various prognostic factors available to the surgical pathologist, the presence of cellular expression of carcinoembryonic antigen in tumor tissue will aid in predicting the prognosis of patients with gastric carcinoma.

Detection of five different human papillomavirus types in cervical lesions by in situ hybridization. A study of 110 cases using sulfonated probes.

Several findings suggest an etiologic relationship between genital tract squamous cell carcinoma and certain types of human papillomavirus (HPV). Detection of these HPV types in cervical lesions considered as preneoplastic states (ie, cervical intraepithelial neoplasia or CIN) is extremely important but difficult because the morphology of these states is highly heterogeneous and clinical course is rarely predictable. In situ hybridization (ISH) is the only technique allowing correlation between HPV type and tissue or cell morphology. In this report, 110 biopsy specimens from uterine cervix lesions were studied: 66 CIN, 10 invasive carcinoma, 28 metaplasia, and six condyloma acuminata. A new ISH technique based on direct modification of DNA probes by sulfonation was used. The hybridized DNA was revealed first by a specific monoclonal antibody against sulfonated DNA, and then by an alkaline phosphatase system. In order to determine the sensitivity level of this method, 14 biopsy specimens were also submitted to Southern blot hybridization. Five probes were used separately (HPV 6, 11, 16, 18, and 33) for each biopsy specimen. Results of ISH were correlated with morphologic criteria such as number of koilocytes and mitoses. Oncogenic HPV was found exclusively in CIN. The number of labeled cells varied with CIN grade. These data suggest that, whatever the grade, CIN represents a unique preneoplastic process, and that HPV replication depends on the squamous maturation of the pathologic epithelium.