[Safety and 12-month results on stage 3-4 cystocele repair by the vaginal route using a light-weight mesh]. / Tolérance et résultats à 12 mois d'une prothèse légère pour la cure de cystocèle de stade 3-4 par voie vaginale.

OBJECTIVE: To assess safety and efficacy at short-term of a light-weight polypropylene mesh (28 g/m2) for stage 3-4 cystocele repair by the vaginal route. MATERIAL AND METHODS: A multicentric prospective cohort study, performed between 2010 and 2011 in seven centers. Pre-operative assessment included prolapse quantification using the POP-Q. Pre- and postoperative validated symptoms and quality of life questionnaires were used. Main objective was mesh safety. Secondary objectives were anatomical and functional success. RESULTS: One hundred and eleven patients, with a mean age of 67±9 years, were included in the study, and 94 were included in the analysis (84.7%). In 14 cases (12.8%), it was a secondary surgery. Two intra-operative complications occurred (2.2%). Safety analysis on 86 patients followed up at 12 months (91.5%) has shown satisfaction rate of 98.8% (85/86), mesh contraction rate of 9.3% (8/86), one case of vaginal mesh exposure (1.2%), no cases of pelvic pain and rate of postoperative dyspareunia of 5.5% (3/55). Anatomic success rate on cystocele (Ba point < -1) at short-term was 82/86 (95.3%) and improvement of symptoms and quality of life was highly significant. Five patients (5.3%) were reoperated. CONCLUSION: Cystocele repair by the vaginal route using a light-weight transobturator polypropylene mesh was safe and efficient at short-term. Long-term data are needed.

[HPV detection and typing by INNO-LiPA assay on liquid cytology media Easyfix Labonord after extraction QIAamp DNA Blood Mini Kit Qiagen and Nuclisens easyMAG Biomérieux]. / Dépistage et typage des infections à HPV par technique INNO-LiPA sur milieu liquide Easyfix Labonord après extraction QIAamp DNA Blood Mini Kit Qiagen et Nuclisens easyMAG Biomérieux.

OBJECTIVES: The objective of this study is to validate the use of test INNO-LIPA HPV Genotyping Extra (Innogenetics) on liquid cytology media EasyFix Labonord by comparing the extraction kit QIAamp DNA Blood Mini Kit (Qiagen) and an automated method, Nuclisens easyMAG (Biomérieux). METHODS: Thirty-two samples were typed by the technique Hybrid Capture 2 (HC2) Digene (Qiagen). DNA was extracted through manual or automated extraction and quality controlled PCR "HLA". Typing was performed with the INNO-LIPA test. A nested PCR followed by sequencing was used to compare different results. RESULTS: Similar results were found for the two types of extraction, with an increase of sensitivity after automated extraction. Among the nine patients with a negative result with the HC2 test, seven had a negative result in INNO-LIPA and two a positive result (one untypable and one HPV66). On the 23 patients with a positive result with the HC2 test, 17 are consistent results. The six discordant results include one negative, one HPV54, two untypable HPV and two HPV53. The overall concordance between the HC2 and INNO-LIPA tests is 81% with a kappa test of 0.79. CONCLUSION: Coupled with an automated extraction, the test INNO-LIPA confirmed its high sensitivity for detecting and typing HPV in the EasyFix media Labonord, especially in the presence of multiple genotypes. This typing systematic approach is becoming increasingly relevant in the context of HPV vaccination.

[Testing of a new probe 16/18/45 Hybrid Capture (Digene) in women with high risk HPV infection]. / Evaluation d'une sonde spécifique HPV 16, 18 et 45 Hybrid Capture (Digene) chez des patientes présentant une infection à HPV haut risque oncogène.

BACKGROUND: HPV HR detection test are needed when ASCUS is diagnosed on Pap test. The risk of progression to cervical cancer is dependant on the HPV genotype and three types (HPV 16, 18 and 45) are found in 77.4% of the cervical cancer. Here we have tested a new probe 16/18/45 (Digene) that is able to detect specifically these three types. MATERIAL AND METHODS: Thirty-seven women with a Hybrid Capture 2 High Risk test (Digene) positive were selected to test the new probe 16/18/45. Samples were typed using sequencing reaction after GP5+/GP6+ PCR. Types were given after comparison with the GenBank. Discordant results were controlled with Inno-Lipa HPV genotyping v2 test (Innogenetics). RESULTS: Among the 37 women with HR HPV result, 48.6% were positive with the probe 16/18/45 (18 patients). After genotyping, 12 results were concordant and six discordant (three HPV 31, two HPV 58 et one HPV 59). For the other 19 patients with negative result, 18 are concordant and one discordant (HPV 18). Global concordance for typing between this probe and sequencing was 81% with a kappa test of 0.62 that means a good concordance. Positive predictive value is 66.6% and negative predictive value is 94.7%. CONCLUSION: This study shows a good efficiency of the 16/18/45 probe to detect the genotypes that have the higher risk of progression to cervical cancer. This probe could also allow to follow the epidemiology of HR HPV infection after a large use of HPV vaccines.

[Evaluation of accuracy of three assays for human papillomavirus detection and typing: Hybrid Capture 2, HPV Consensus kit and Amplicor HPV]. / Evaluation des performances de trois techniques de détection et de typage des papillomavirus humains: Hybrid Capture 2, HPV Consensus kit et Amplicor HPV.

BACKGROUND: Detection of high-risk human papillomavirus has proved its usefulness in complement of abnormal cervical scrape result. The Hybrid Capture 2 (HC2, Digene) test has proven its efficiency. We have compared this test with HPV Consensus kit (HPVC, Argène) and Amplicor HPV test (AHPV, RocheDiagnostics) on a panel of 88 samples with low HC2 ratios or discordant results between HC2 and cervical scrape. MATERIAL AND METHODS: Cervical samples were tested in parallel by the three methods using a nested amplification of L1 region as reference. RESULTS: Eighty-six samples were suitable for analysis. Results of HC2 and AHPV tests were closely related. The use of a "generic" probe in the HPVC test was responsible for undetermined results, which were not clinically relevant. CONCLUSION: Despite the low viral load of the samples chosen, the hybridization (HC2) and PCR (AHPV or HPVC) methods gave comparable results, with false positive and false negative results for all tests, but a 75% concordance and a high sensibility to detect HPV infection. However, a complementary study on a larger population with ASCUS diagnosis and biopsy under colposcopy would be necessary to valid these assays for a clinical indication.

[Concentration of amoxicillin in neonates after infusion to the mother during labor]. / Concentration d'amoxicilline chez le nouveau-né après perfusion de la mère durant le travail.

Amoxicillin is effective against S. agalactiae (MIC 50 = 0.03 mg/l). Neonatal prophylaxis of GBS infection had already been studied but very few data are available regarding pharmacokinetic of these antibiotics. In this study, 58 pregnant women with GBS colonisation and/or with epidemiologic risk factors received intrapartum antibiotic infusion at the beginning of the labor (1 g amoxicillin every 6 hours until the delivery). At delivery, cord blood and gastric fluid were taken in delay from 0.5 to 6 hours after the beginning of the infusion. Dosages were done in triplicate with a microbiological method using Bacillus subtilis ATCC 6633 as test strain. In cord blood amoxicillin appeared as early as the first half hour. Concentration were from 5 to 7 mg/l between 1 hour and 4 hours after the beginning of the infusion, and from 3 to 4 mg/l after 4 hours. In gastric fluid, concentrations obtained were over 1 mg/l after 1.5 hour and over 3 mg/l after 2.5 hours with good efficiency even after the sixth hour. The protocol using a slow intrapartum amoxicillin infusion (1 g) gave concentrations in gastric fluid and cord blood over S. agalactiae MIC.

[Perineal rehabilitation of female urinary incontinence. Long term results]. / Rééducation périnéale au cours de l'incontinence urinaire féminine. Résultats à distance.

The results of perineal rehabilitation in 101 women with urinary incontinence are evaluated with a follow-up of 18 months (9-37 months). The authors try to precise the clinicals and urodynamicals initials factors of a bad pronostic.

[Diagnosis and treatment of cervical dysplasia. Report of 42 cases]. / Diagnostic et traitement des dysplasies cervicales. A propos de 42 cas.

The authors present a retrospective study of 42 cases of conization carried out between January 1987 and October 1989 in the Department of Gynaecology 1 of Dupuytren University Hospital in Limoges. The average age of the population was 42 years and 7 months, with an average parity of 1.9 children per woman. Conization was carried out using either a cold knife (37 cases) or an electric knife (5 cases). Complications consisted of 4 stenoses, 2 secondary haemorrhages and 1 perineal burn. 4 microinvasive cancers, 7 CIN III, 10 CIN II, 4 CIN I and 3 pieces of tissue free from any dysplastic lesion were found on histological examination of the conization tissue. 17 patients (40.4%) had flat condylomas. There was perfect agreement between the diagnoses from the smears and biopsies in 82.1 p. cent of cases; there was 57.1 p. cent agreement when the smear result was compared with the histological study of the conization tissue, and 39.2 p. cent agreement when the latter was compared with biopsy results. On the other hand, false diagnosis due to overevaluation of the severity of the dysplasia was predominant using the least invasive examination (42.8 p. cent when comparing the smear results with those from the study of conization tissue, and 39.2% for biopsies with respect to the conizations). According to the authors, the therapeutic strategy to be used in treating dysplasia must take the severity of the dysplasia, the presence of infection due to HPV and its serotyping, the location and size of the dysplasia, the visibility of the endo-exocol junction line and the psychological context of the patient into consideration.

[Endometriosis localized in the sigmoid. Apropos of a case]. / Endométriose à localisation sigmoïdienne. A propos d'un cas.

Colic endometriosis is a classical but rare localization. The authors present one case treated by partial colectomy associated with a total hysterectomy and preservation of ovarian parenchyma. The hysterectomy was necessary because of adenomyosis and inflammatory adhesions undissociable from the sigmoid.

[Rupture during pregnancy of the rudimentary horn of a pseudo-unicorn uterus. Apropos of a case]. / Rupture per-gravidique de la corne rudimentaire d'un utérus pseudo-unicorne. A propos d'un cas.

The rupture of the rudimentary horn of a pseudo-unicorn uterus is a rare accident. The case reported here is very similar to most of those published. It is usually during the fifth month of a pregnancy, normal until then, that a state of shock appear suddenly, requiring a surgical procedure and disclosing this exceptional diagnosis.