[Pap Smear after 65 years]. / Pratique du frottis cervicovaginal après 65 ans.

The French recommendations (in favor of stopping cervical cancer screening by cervico-uterine smear from 65 years of age) are logical in the context of organized screening; however, it is not yet generalized in France. The proportion of invasive cervical cancer in the oldest patients is high and these cancers are more evolved and have a more pejorative prognosis. The prevalent infection with high-risk HPV virus remains important in elderly patients: if the HPV infection does not appear to be more risky in the elderly, HPV-induced lesions appear to be more evolving. Unfortunately, pap smear coverage rates are low in the most advanced age groups. Patients without adequate follow-up are exposed to invasive cancer after age 65: all studies insist on the protective effect of two or more normal pap smears between 50 and 65 years that would allow to stop screening. Recent publications in Europe insist, however, on the value of continuing screening beyond the age of 65 in populations that live longer. For the clinician, in France, patients who could benefit from systematic FCU after age 65 could be those: (1) who request it, (2) who have an HPV history, (3) who have not had more than 3 consecutive normal pap smears or (4) who have an associated pathogenic condition. The place of the HPV test deserves to be considered: because of its very high negative predictive value, it could be performed as an exit test or as an alternative test to the pap smear.

[Can new molecular profiles in epithelial ovarian cancer modify therapeutics?] / Les nouveaux profils moléculaires dans le cancer de l'ovaire peuvent-ils modifier les stratégies thérapeutiques ?

Epithelial ovarian cancer (EOC) affects 4500 women a year in France, with a survival of 30% at 5 years. Treatment is based on extensive surgery and chemotherapy. Around 15% of EOCs are due to genetic mutation predisposition essentially with mutated BRCA1 and BRCA2 genes. Four histological subtypes are described (serous, endometrioid, and mucinous cells to clear), corresponding to different carcinogenesis and distinct molecular mutations. High-grade serous EOCs have a mutation of the BRCA genes in 20-30% of cases. This mutation causes a deficit of repair by homologous recombination of DNA in case of double strand break, allowing greater sensitivity to platinum salts and the use of PARP inhibitors, a protein involved in the repair of single-strand breaks of DNA. PARP inhibitors have shown efficacy in patients mutated BRCA but this effectiveness remains to be demonstrated in patients without congenital mutation, but with acquired BRCAness profile EOC. The BRCAness profile is defined by a tumor having a defect in DNA repair counterpart (not limited to BRCA mutation). Molecular definition of BRCAness is still not consensual but is necessary for the use of PARP inhibitors. Gene expression analyses have identified four subgroups of high-grade serous CEO: mesenchymal, proliferative, differentiated and immunoreactive. These four subtypes, not mutually exclusive, although correlated with prognosis, are not yet used in clinical routine.

[Paraplegia after aorto-bifemoral prosthesis: systematized dysautonomic symptoms should evoke spinal cord damage]. / Paraplégie après pontage aorto-bifémoral: des troubles neurovégétatifs systématisés doivent faire évoquer l'accident médullaire.

We report a case of paraplegia following aorto-bifemoral by-pass surgery for infrarenal aortic occlusive disease. The first symptoms of spinal cord damage were systematized dysautonomic symptoms including mottled skin and sudation. Such symptoms, occurring during recovery from anaesthesia are an indication for checking the status of the spinal cord.

[Short-term obstetrical anesthesia. Study of the tiapride-ketamine combination]. / Anesthésie de courte durée en obstétrique. Etude de l'association tiapride-kétamine.

Minor surgical procedures do not always require hospitalisation for several days. The use of short-acting anaesthetic agents should make such procedures possible on an ambulatory basis. A study was undertaken of the combination of tiapride and ketamine in 97 women seen in the department of obstetrics for therapeutic abortion or biopsy-curettage. The drug combination was satisfactory in the great majority of cases. It is sufficiently analgesic for surgery of this type. The minimal level of narcosis ensures rapid recovery without any subsequent falling asleep again. The psychomotor agitation caused by ketamine is counteracted by the doses of tiapride used. Only vomiting may be felt to be too frequent. Nevertheless, this occurred in women who were fully awake and had no major consequences.