[Results, safety and patient satisfaction at 6 months of vaginal anterior wall prolapse surgery by transvaginal repair with mesh use]. / Résultats, tolérance et satisfaction des patientes à 6mois d'une cure de cystocèle par voie vaginale avec pose de prothèse.

OBJECTIVE: To assess at 6 months the efficiency, the safety and the satisfaction of a lightweight polypropylene mesh used for the transvaginal repair of cystocele by bilateral anterior sacrospinous ligament fixation (NUVIA™ SI). MATERIEL AND METHODS: A prospective cohort study was performed from January 2014 to June 2015. Preoperative assessment included an evaluation using the Pelvic Organ Prolapse Quantification system (POP-Q) and 3 questionnaires about symptoms, quality of life and quality of sex life (PFDI-20, PFIQ7, PISQ-12). Results were evaluated by a composite criteria: Ba≤0, absence of bulge sensation and absence of reoperation for cystocele recurrence. Secondary objectives were to assess the complications rates and patient's satisfaction. RESULTS: In 10 months, 16 patients, with a mean age of 61.9±8.8years, were included and evaluated by an independent observator at 6months. Four patients were sexually active before surgery and 5 at 6 months. Results were optimal in 93.75% cases (15/16) with one intraoperative injury (bladder injury) and one postoperative complication (increase of preoperative dyspareunia). Satisfaction rate was 93.75% (15/16) and questionnaires PFDI-20 and PFIQ-7 were statistically improved (P<0.0001 and P=0.0013). Three patients had a reintervention but not about anterior wall prolapse (section of a suburethral sling for urinary retention, suburethral sling exposure and cure of stress urinary incontinence). CONCLUSION: At short term, transvaginal mesh repair by anterior sacrospinous ligament fixation with NUVIA™ presents 93.75% optimal result with one case of increased dyspareunia and 3 reoperations which don't concern anterior wall (urinary outcomes). LEVEL OF EVIDENCE: 4.

[Vaginal mesh exposure after prolapse surgery. A descriptive study of 43 cases: Epidemiology and therapeutic management]. / Expositions prothétiques vaginales après chirurgie du prolapsus. Étude descriptive sur 43 cas: épidémiologie et prise en charge thérapeutique.

OBJECTIVE: To describe the prevalence and time of occurrence of vaginal mesh exposure based on the initial surgical approach of prolaps. To describe their therapeutic management. MATERIAL: Descriptive retrospective study of 43 women followed for vaginal mesh exposure diagnosed during a follow-up visit or motivated by symptoms. The initial surgery was performed abdominally (promontofixation) or vaginally. The therapeutic management was carried out by medical and/or surgical (prosthetic resection partial or complete). RESULTS: The prevalence of vaginal exposure was 7.3% in case of vaginal initial surgery and 2.8% in case of promontofixation initial (P=0.02). Mesh exposure have appeared earlier in case of vaginal initial surgery compared to promontofixation (14.9 months vs. 45.2 months). After vaginal initial surgery, vaginal mesh exposure appeared to third within 6 months postoperatively (9/29). The success rate of medical treatment was 21.4%. In total, 31% of women initially made vaginally and 64.9% of women initially made abdominally required at least two surgeries to get a cure. CONCLUSION: Vaginal mesh exposure may be away from the initial surgery, especially when the first initial surgery was abdominal. The medical treatment of vaginal mesh exposure led to poor results. The overall rate of healing in our experience was good but at the cost of considerable morbidity as a significant proportion of patients required two or more surgical interventions.

[No improvement in live birth rate after luteal phase support by GnRH agonist]. / Absence d'amélioration du taux de naissance vivante après soutien de la phase lutéale par agoniste de la GnRH.

OBJECTIVES: To evaluate the impact of adding a GnRH agonist (GnRH-a) in luteal phase support (LPS) on live birth rates in IVF/ICSI in antagonist protocols. METHODS: In total, 341 IVF/ICSI attempts are analyzed in this retrospective study. Patients were divided into two groups: A f: LPS with progesterone alone (179 attempts) between March 2019 and May 2020; B: LPS with progesterone and an injection of triptorelin (GnRH-a) 0.1mg 6 days after oocyte retrieval (162 attempts) between June 2020 and June 2021. The primary outcome was live birth rate. The secondary outcomes were miscarriage rate, pregnancy rate and ovarian hyperstimulation syndrome rate. RESULTS: The baseline characteristic are identical between the two groups except the infertility duration (longer in the group B). There was no significant difference between the two groups in live birth rate (24.1% versus 21.2%), pregnancy rate (33.3% versus 28.1%), miscarriage rate (4.9% versus 3.4%) and no increase the SHSO rate. The multivariate regression analysis after adjustment for age, ovarian reserve and infertility duration did not reveal a significant difference in live birth rate between the two groups. CONCLUSION: In this study, the results showed no statistically significant association with the single injection of a GnRH-a in addition to progesterone on live birth rate in luteal phase support.

Management of postmenopausal women: Collège National des Gynécologues et Obstétriciens Français (CNGOF) and Groupe d'Etude sur la Ménopause et le Vieillissement (GEMVi) Clinical Practice Guidelines.

AIM: The aim of these recommendations is to set forth an individualized approach to the management of early postmenopausal women (i.e., within the first 10 years after natural menopause) covering all aspects of lifestyle and therapeutic management, with or without menopause hormone therapy (MHT). MATERIALS AND METHODS: Literature review and consensus of French expert opinion. Recommendations were graded according to the HAS methodology and levels of evidence derived from the international literature, except when there was no good-quality evidence. SUMMARY RECOMMENDATIONS: The beginning of menopause is an ideal time for each woman to evaluate her health status by assessing her bone, cardiovascular, and cancer-related risk factors that may be amplified by postmenopausal estrogen deficiency and by reviewing her lifestyle habits. Improving lifestyle, including nutrition and physical activity, and avoiding risk factors (notably smoking), should be recommended to all women. MHT remains the most effective treatment for vasomotor symptoms but it could be also recommended as first-line treatment for the prevention of osteoporosis in early postmenopausal women at low to moderate risk for fracture. The risks of MHT differ depending on its type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. There is reasonable evidence that using transdermal estradiol in association with micronized progesterone or dydrogesterone may limit both the venous thromboembolic risk associated with oral estrogens and the risk of breast cancer associated with synthetic progestins. Treatment should be individualized to each woman, by using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of its benefit-risk balance. For bothersome genitourinary syndrome of menopause (GSM) symptoms, vaginal treatment with lubricants and moisturizers is recommended as first-line treatment together with low-dose vaginal estrogen therapy, depending on the clinical course. No recommendation of an optimal duration of MHT can be made, but it must take into consideration the initial indication for MHT as well as each woman's benefit-risk balance. Management of gynecological side-effects of MHT is also examined. These recommendations are endorsed by the Groupe d'Etude sur la Ménopause et le Vieillissement hormonal (GEMVI) and the Collège National des Gynécologues-Obstétriciens Français (CNGOF).

[Genitourinary menopause syndrome. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. / Syndrome génito-urinaire de la ménopause (SGUM). RPC les femmes ménopausées du CNGOF et du GEMVi.

INTRODUCTION: Genitourinary menopause syndrome (SGUM) is defined as a set of symptoms associated with a decrease of estrogen and other sexual steroids during menopause. The main symptoms are vulvovaginal (dryness, burning, itching), sexual (dyspareunia), and urinary (urinary infections, pollakiuria, nycturia, pain, urinary incontinence by urgenturia). SGUM leads to an alteration of the quality of life, and affects especially women's sexuality. OBJECTIVE: The objective of this review was to elaborate guidelines for clinical practice regarding the management of SGUM in postmenopausal women, and in particular, in women with a history of breast cancer, treated or not with hormone therapy. MATERIALS AND METHODS: A systematic review of the literature on SGUM management was conducted on Pubmed, Medline and Cochrane Library. Recommendations from international scholarly societies were also taken into account: International Menopause Society (IMS) https://www.imsociety.org, The North American Menopause Society (NAMS) https://www.menopause.org, Canadian Menopause Society https://www.sigmamenopause.com, European Menopause and Andropause Society (EMAS) https://www.emas-online.org, International Society for the Study of Women's Sexual Health (ISSWSH) https://www.isswsh.org. RESULTS: Vaginal use of lubricants, moisturizers and hyaluronic acid improves the symptoms of SGUM and may be offered to all patients. For postmenopausal women, local estrogen will be preferred to the oral route because of their safety and efficacy on all symptoms of SGUM during low-dose use. Prasterone is a local treatment that can be proposed as an effective alternative for the management of dyspareunia and sexual function disorder. Current data on oral testosterone, tibolone, oral or transdermal DHEA and herbal medicine are currently limited. Ospemifène, which has shown a significant improvement in sexual symptoms, is not currently marketed in France. In the particular case of women with a history of breast cancer, non-hormonal regimens are a first-line therapy. Current data on the risk of breast cancer recurrence when administering low-dose local estrogen are reassuring but do not support a conclusion that this treatment is safe. CONCLUSION: SGUM is a common symptom that can affect the quality of life of postmenopausal women. A treatment should be systematically proposed. Local non-hormonal treatment may be offered in all women. Local low-dose estrogen therapy and Prasterone has shown an interest in the management of symptoms. In women before a history of breast cancer, local non-hormonal treatment should be offered first-line. The safety of low-dose local estrogen therapy and Prasterone cannot be established at this time. Other alternatives exist but are not currently recommended in France due to lack of data.

Protocol for a randomized controlled trial to assess two procedures of vaginal native tissue repair for pelvic organ prolapse at the time of the questioning on vaginal prosthesis: the TAPP trial.

BACKGROUND: Native tissue cystocele repair has been the cornerstone of prolapse surgery, especially since the learned societies warned clinicians and patients about serious mesh-related complications. Surgical techniques mainly consist in anterior colporraphy and vaginal patch plastron. However, success rates of native tissue cystocele repair are heterogeneous, depending on the design of studies and definition of outcomes. To date, high-quality data comparing vaginal native tissue procedures are still lacking. METHODS: Herein we aimed to describe the design of the first randomized controlled trial (TAPP) comparing anterior colporraphy (plication of the muscularis and adventitial layers of the vaginal wall) and vaginal patch plastron (bladder support anchored on the tendinous arch of the pelvic fascia by lateral sutures) techniques. Our aim is to assess the effectiveness of vaginal native tissue repair at 1 year for cystocele with a combined definition of success-anatomic and functional. The primary endpoint will be the success rate 1 year after surgery with a composite of objective and subjective measures (Aa and Ba points < 0 from POP-Q (Pelvic Organ Prolapse Quantification System) and a negative answer to question 3 of Pelvic Floor Distress Inventory and no need for additional treatment). DISCUSSION: A prospective study has found a success rate at 35% for anterior colporraphy based on a combined definition, both anatomic and functional, as recently recommended. However, the definition of anatomic was strict (POP-Q< 2), while it seems that the best definition of anatomic success is "no prolapse among the hymen", that is to say Aa and Ba points from the POP-Q classification < 0. We hypothesize that vaginal patch plastron will have a better anatomic and functional success comparatively to anterior colporraphy because native tissue is added, as it corrects both median and lateral cystoceles thanks to bilateral paravaginal suspension. TRIAL REGISTRATION: CHU LIMOGES is the sponsor of this research (n°87RI18_0013). This research is supported by the French Department of Health (PHRC 2018-A03476-49) and will be conducted with the support of DGOS (PHRC interregional - GIRCI SOHO). The study protocol was approved by the Human Subjects Protection Review Board (Comité de Protection des Personnes) on May 16, 2019. The trial is registered in the ClinicalTrials.gov registry ( NCT03875989 ).

[Management of erosive complications after tension-free vaginal tape procedure]. / Prise en charge des complications érosives après mise en place d'une bandelette sous-urétrale.

OBJECTIVE: To describe the management of patients with an erosive complication after tension free vaginal tape. To establish a diagnostic approach, describe the results on symptoms and continence after a conservative surgery. METHODS: Retrospective descriptive study of 38 patients supported for complications after suburethral synthetic sling. We have diagnosed 12 erosions vaginal and five bladder erosions. Patients have been treated from a recovery surgery according to a conservative approach (partial resection or endoscopic section). RESULTS: Of the 12 patients with a vaginal erosion, 10 expressed symptoms in relation with their erosion. After partial resection, eight patients (80% of patients with symptomatic erosion) did not have more complain. Of these, 50% were continent, the other with mostly a slight recurrence accessible to a second suburethral sling. First endoscopic section was a minimally invasive option for bladder erosion. However, an only cystoscopic approach seemed to be not sufficient to cut the sling as far as possible. After section, two patients have been treated from a laparotomy with bladder dissection, one for immediate outcome unsatisfactory, the other for reccurent symptoms. The results for continence were excellent as the suburethral portion was not resected. CONCLUSION: Our study showed the importance of regular clinical surveillance, feasibility and the relative success of this conservative approach. The technical feasability and the increasing number of patients must not forget to respect good indication and rigorous technique. These complications invite us to moderate our indications especially for young patients.

[Contraception for women after 40: CNGOF Contraception Guidelines]. / La contraception après 40 ans. RPC Contraception CNGOF.

INTRODUCTION: Choosing contraception for women over 40 can be sometimes difficult but it is crucial since fertility and pregnancy's risks still exist. It requires a thorough evaluation of the situation, in order to identify any vascular and metabolic risk factors, along with the uterine and mammary benign pathologies already diagnosed. OBJECTIVE: The objective of this review was to elaborate some guidelines for clinical practice regarding contraception's prescription for women over 40. METHODS: A systematic review of the French and English existing literature was conducted. Pubmed and the Cochrane library were used to identify studies about contraception for perimenopausal women. International guidelines published by scientific societies were also reviewed (RCOG, FSRH, ESHRE, ACOG, WHO, HAS). RESULTS: No contraceptive methods are contraindicated on the sole basis of age alone. However, because age is a risk factor for vascular and metabolic diseases, combined hormonal contraception and DMPA should not be prescribed at first intention. Copper IUD and progestin-only contraceptives (pill, implant, intrauterine device) should primarily be considered, since they offer good efficacy with lower risks. CONCLUSIONS: Contraception for women over 40 should not be put aside. Long acting reversible contraception and progestin-only pill have to be prescribed as first-ine. Contraception is no longer needed for women over 50 who use non-hormonal contraception, after a 12 month-amenorrhea. Patients treated with combined hormonal contraception must stop using it over 50. Measuring hormonal levels while using hormonal contraception is not recommended. An hormonal-contraception-free interval must be considered, while using barrier contraception method. If an ovarian activity persists, a non-hormonal contraception or progestin-only contraception (except for DMPA) should be (re-)established.

[Extragenital endometriosis: Parietal, thoracic, diaphragmatic and nervous lesions. CNGOF-HAS Endometriosis Guidelines]. / Endométriose extra-génitale : atteinte pariétales, thoraciques, diaphragmatiques et nerveuses. RPC Endométriose CNGOF-HAS.

According to some studies, extragenital endometriosis represents 5% of the localisations. Its prevalence seems to be underestimated. The extra pelvic localisation can make the diagnosis more difficult. Nevertheless, the recurrent and catamenial symptomatology can evoke this pathology. Surgery seems to be the unique efficient treatment for parietal lesions. Pain linked to nervous lesions (peripheric and sacral roots) seems to be underestimated and difficult to diagnose because of various localisations. Neurolysis seems to have encouraging results. Diaphragmatic lesions are often discovered either incidentally during laparoscopy, or by pulmonary symptomatology as recurrent catamenial pneumothorax or cyclic thoracic pain. Surgical treatment seems as well to be efficient.

Specific accumulation of 18F-deoxyglucose in three-dimensional long-term cultures of human and rodent brain tissue.

AIM: Organotypic slice cultures (OSC) of human brain specimens represent an intriguing experimental model for translational studies addressing, e.g., stem cell transplantation in neurodegenerative diseases or targeting invasion by malignant glioma ex vivo. However, long-term viability and phenomena of structural reorganization of human OSC remain to be further characterized. Here, we report the use of (18)F-deoxyglucose (FDG) for evaluating the viability of brain slice preparations obtained either from postnatal rats or human hippocampal specimens. METHODS: Anatomically well preserved human hippocampi obtained from epilepsy surgery and rat hippocampus slice cultures obtained from six day old Wistar rats were dissected into horizontal slices. The slices were incubated with FDG in phosphate buffered saline up to 1 h, either with or without supplementation of glucose at a concentration of 2.5 mg/ml. Radioactivity within the medium or slice cultures was measured using a gamma-counter. In addition, distribution of radioactivity was autoradiographically visualized and quantified as counts per mm(2). RESULTS: In rat hippocampal slices, FDG accumulated with 1 300 000 +/- 68 000 counts/mm(2), whereas the incorporation of the radioactive label in human slices was in the order of 1 500 000 +/- 370 000 counts/mm(2). The elevation of glucose concentration within the medium led to a significant three-fold decrease of FDG accumulation in rat slices and to a 2.4-fold decrease in human specimens. CONCLUSIONS: FDG accumulated in organotypic brain cultures of human or rodent origin. FDG is thus suited to investigate the viability of OSC. Furthermore, these preparations open new ways to study the factors governing cerebral FDG uptake in brain tissue ex vivo.

Effect of CT-based attenuation correction on uptake ratios in skeletal SPECT.

UNLABELLED: The AIM of this study was to determine the clinical relevance of compensating SPECT data for patient specific attenuation by the use of CT data simultaneously acquired with SPECT/CT when analyzing the skeletal uptake of polyphosphonates (DPD). Furthermore, the influence of misregistration between SPECT and CT data on uptake ratios was investigated. METHODS: Thirty-six data sets from bone SPECTs performed on a hybrid SPECT/CT system were retrospectively analyzed. Using regions of interest (ROIs), raw counts were determined in the fifth lumbar vertebral body, its facet joints, both anterior iliacal spinae, and of the whole transversal slice. ROI measurements were performed in uncorrected (NAC) and attenuation-corrected (AC) images. Furthermore, the ROI measurements were also performed in AC scans in which SPECT and CT images had been misaligned by 1 cm in one dimension beforehand (ACX, ACY, ACZ). RESULTS: After AC, DPD uptake ratios differed significantly from the NAC values in all regions studied ranging from 32% for the left facet joint to 39% for the vertebral body. AC using misaligned pairs of patient data sets led to a significant change of whole-slice uptake ratios whose differences ranged from 3,5 to 25%. For ACX, the average left-to-right ratio of the facet joints was by 8% and for the superior iliacal spines by 31% lower than the values determined for the matched images (p < 0.05). CONCLUSIONS: AC significantly affects DPD uptake ratios. Furthermore, misalignment between SPECT and CT may introduce significant errors in quantification, potentially also affecting left-to-right ratios. Therefore, at clinical evaluation of attenuation-corrected scans special attention should be given to possible misalignments between SPECT and CT.

[Surgical treatment of stress urinary incontinence by suburethral transobturator tape]. / Cure chirurgicale de l'incontinence urinaire d'effort par bandelette sous-urétrale transobturatrice.

OBJECTIVE: Assessment of the suburethral transobturator tape in the treatment of female urinary stress incontinence. PATIENTS AND METHODS: Retrospective evaluation of 39 slings. Three patients (7%) were lost to follow-up. Analysis was carried on 19 out/in procedures (mainly ObTape and Uratape slings) and 17 in/out procedures (TVT-O slings). Nine patients (25%) had a history of previous stress incontinence surgery. In 21 cases (58%) there was a concomitant surgical procedure, including genital prolapse repair (12) and total hysterectomy (6). Phone interviews were conducted with the validated questionnaires MHU and Ditrovie short form. RESULTS: The mean operative time was 17 minutes (10-30). Three vaginal wounds (8%) were immediately repaired. Two urinary retentions (5%) were managed by suprapubic catheterization for more than 10 days. With a mean follow-up of 12 months (4-23) the subjective effectiveness on stress incontinence was 89% (cure: 58%; improvement: 31%). Urge incontinence symptoms were cured in 47% of mixed incontinences. Two patients reported an important dysuria. Two sling exposures occurred. Quality of life scores were significantly improved (mean 1,7 versus 3,2, p=0,002). The level of satisfaction reached 89% (very satisfied: 50%; satisfied: 39%). DISCUSSION AND CONCLUSION: This technique is safe and effective. Our results are nevertheless inferior to those previously reported. Prospective randomised studies comparing the two surgical routes are required.

Tissue distribution of radioiodinated FAUC113: assessment of a pyrazolo(1,5-a) pyridine based dopamine D4 receptor radioligand candidate.

AIM: Disturbances of the D4 receptor subtype have been implicated in the genesis of a broad range of psychiatric disorders. In order to assess the suitability of a radioiodinated analogue of the D4-selective ligand FAUC 113 for tracer studies in vivo, we investigated the in-vivo stability, biodistribution and brain-uptake of 7-(131)I-FAUC 113 in Sprague-Dawley rats. METHODS: Radiolabelling was carried out with high radiochemical yield and specific activity. After intravenous injection, blood and tissue samples, taken at designated time intervals, were collected for analysis. Analyses of metabolites were performed by radio-hplc and radio-tlc. For in-vivo evaluation, sagittal cryo-sections of the rat brain were investigated by in-vitro and ex-vivo autoradiography on a mu-Imager system. RESULTS: 7-(131)I-FAUC 113 was rapidly cleared from blood. Highest uptake was observed in kidney (0.603 +/- 0.047% ID/g, n = 4) and liver (0.357 +/- 0.070% ID/g, n = 4) at 10 min p.i.; 7-(131)I-FAUC 113 displayed rapid uptake (0.21-0.26% ID/g) and fast clearance in various brain regions consistent with the determined logP-value of 2.36 +/- 0.15 (n = 4). In-vivo stability of 7-(131)I-FAUC 113 was confirmed in the frontal cortex (>95%). Ex-vivo autoradiography revealed a frontal cortex-to-cerebellum ratio of 1.57 +/- 0.13 at 10 min p.i. (n = 6). Coinjection with L-750667 could not suppress any putative specific binding of 7-(131)I-FAUC 113. In-vitro autoradiography using authentic 7-iodo-FAUC 113 or L-750667 failed to cause significant displacement of the radioligand. CONCLUSIONS: Radioiodinated FAUC 113 does not allow imaging of D4 receptors in the rat brain in vivo nor in vitro. Further work should aim at the development of selective dopamine D4 radioligands with improved tracer characteristics, such as receptor affinity and subtype selectivity, specific activity or blood-brain barrier permeability.

[Repeated in vitro fertilization failure: Abnormalities identified in the diagnostic assessment]. / Échecs répétés de fécondation in vitro : anomalies retrouvées sur le bilan diagnostique.

OBJECTIVES: Investigate the proportion of abnormalities identified on the diagnostic assessment performed after at least two previous failed IVF attempts. Discuss the real benefit of this evaluation. METHODS: Retrospective descriptive study. Between January 2008 and January 2012, 205 couples with at least two consecutive failed IVF attempts had a diagnosis evaluation which consisted in couple's karyotypes; autoimmune and haemostasis biological check-up, pelvic ultrasound-Doppler and hysteroscopy for women. RESULTS: The main biological anomalies were autoimmune for 23.9% of women: antinuclear antibodies (5.7%), antithyroid peroxidase (11.5%) and antithyroglobulin (8.3%); thrombotic with antiphospholipid antibodies for 8.2% of women (1.4% lupus anticoagulant and 6.8% anticardiolipin antibodies), and heterozygous prothrombin gene mutation for 9.5%. Karyotypes were abnormal for 2.1% of women and 0% of men. Ultrasound-Doppler appeared to be abnormal in 44.7% of cases (pulsatility index of uterine artery≥3 and/or protodiastolic notch), and diagnostic hysteroscopy was abnormal in 14.6% of cases. In order to target the real implantation failure, we compared the groups "<8 embryos transferred" versus "≥8 embryos transferred" and "pregnancy after the third or fourth IVF cycle" versus "no pregnancy", but no statistically significant difference was found. CONCLUSION: The diagnostic assessment carried out for recurrent IVF failure can detect biological, karyotypic and morphological abnormalities, in the same proportion that in previous studies. Further studies will have to be conducted to evaluate the real impact of these abnormalities in the recurrent implantation failure and the effectiveness of therapeutic care.

Prospective cohort study of the effect of pregnancy on the progression of human immunodeficiency virus infection. The Groupe d'Epidémiologie Clinique Du SIDA en Aquitaine.

OBJECTIVE: To study the prognostic role of pregnancy on the progression of human immunodeficiency virus (HIV) infection. METHODS: In a prospective cohort study at the Bordeaux University Hospital, France, 57 women who completed a pregnancy during the course of their HIV infection were compared with 114 HIV-infected women who never conceived. The two groups were matched on CD4 lymphocyte count (CD4), age, and year of HIV diagnosis. The main outcome measures were death, occurrence of a first AIDS-defining event, and drop of the CD4 below 200/mm3. RESULTS: The mean follow-up period in pregnant women was 61 months from HIV diagnosis (median CD4 at entry 455/mm3) and 54 months from beginning of pregnancy. Nonpregnant women were followed-up for 50 months since HIV diagnosis (median CD4 460/mm3). The proportion of asymptomatic women at entry in the study was 51 of 57 (90%) in pregnant and 87 of 114 (76%) in nonpregnant women. No significant difference was observed between the two groups with regard to the different end points studied, even after adjustment for other prognostic variables. Adjusted hazard ratios (pregnant/nonpregnant) were 0.92 for death (95% confidence interval [CI] 0.40-2.12), 1.02 for occurrence of a first AIDS-defining event (95% CI 0.48-2.18), and 1.20 for drop of the CD4 to less than 200/mm3 (95% CI 0.63-2.27). CONCLUSION: In a cohort of HIV-infected women with mild to moderate immunosuppression, pregnancy did not accelerate progression to AIDS or death.

Detection of Chlamydia trachomatis in symptomatic and asymptomatic populations with urogenital specimens by AMP CT (Gen-probe incorporated) compared to others commercially available amplification assays.

The present study was designed to evaluate the sensitivity and specificity of AMP CT (Gen-Probe Incorporated, San Diego, CA, USA) on urogenital specimens taken from symptomatic patients and on first void urine (FVU) specimens from asymptomatic patients. In symptomatic patients, 618 specimens from 140 men (140 urethral swabs and 140 FVU) and 202 women (202 endocervical swabs and 136 FVU) were tested by using cell culture, AMP CT and Amplicor Chlamydia trachomatis MWP (microwell plate) (Roche Diagnostics, Somerville, NJ, USA) on genital samples, and AMP CT and Amplicor on FVU. A clinical specimen was considered to be truly positive if either the cell culture was positive and/or both AMP CT and Amplicor were positive. In the asymptomatic population, a total of 300 FVU (136 women and 164 men) were tested by four amplification methods, AMP CT, LCx (Abbott, Abbott Park, IL, USA), Amplicor MWP, and Cobas Amplicor. A subject was considered to be infected when two or more amplification methods were positive. In the symptomatic population (prevalence 13%), concordant results were observed in 320/342 cases (93.5%). After analysis of discordant results, the sensitivity of AMP CT, Amplicor, and culture was 100%, 95.5%, 68.8%, respectively, and the specificity was 98.3%, 99.3%, 100% respectively. The number of false negative results by AMP CT in urine, probably due to labile inhibitors, was 3/276 (1%). In the asymptomatic population, the results were concordant in 298/300 (99.3%), seven positive and 291 negative. Two results were considered false positives, one by Cobas Amplicor, one by AMP CT. Compared to other amplification methods, AMP CT is at least as sensitive for the identification of chlamydial infection in symptomatic and asymptomatic men and women on genital or urine specimens.

Analysis of a series of sixty soft tissue sarcomas in adults treated with a cyclophosphamide-vincristine-adriamycin-dacarbazine (CYVADIC) combination.

From 1976 to 1983, a group of 60 adult patients presenting with metastatic and/or locally advanced soft tissue sarcomas was treated with combination chemotherapy consisting in cyclophosphamide, vincristine, adriamycin, and DTIC (CYVADIC). A tumor response was obtained for 29 patients (48.3%), with 4 (6.7%) cases of complete regression. The median duration of the response was 10 months. Responses were noted in 14/22 patients receiving induction chemotherapy for advanced, and previously nonirradiated, primary tumors; among the patients with metastatic disease tumor regression was recorded in 17/32 patients with pulmonary metastases, but in none of the patients with metastases at other sites. Moreover, the attainment of a response was found to correlated with the patient's general condition, while response duration depended on the histoprognostic grade of the tumors.

Cervical dysplasia and human immunodeficiency virus infection in women: prevalence and associated factors. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GESCA).

OBJECTIVE: To study the prevalence of Cervical Intraepithelial Neoplasia (CIN) and its association with HIV-I infection, controlling for other risk factors of CIN. DESIGN: Cross-sectional survey. SUBJECTS AND METHODS: HIV-1 seropositive (HIV+) and seronegative (HIV-) women were enrolled at the Obstetrics-Gynecologic Departments of the Bordeaux University Hospital from April 1993 to June 1995. A gynecologic check-up was performed with a clinical examination, a colposcopy and a Papanicolaou smear. Sexually Transmitted Diseases (STDs) were screened. Colposcopy was interpreted as: normal, low-grade or high-grade lesions. Interpretation of Papanicolaou smears was based on the 1988 Bethesda system using three descriptive diagnoses: normal, low-grade and high-grade Squamous Intraepithelial lesions (SILs). If colposcopy showed a high grade lesion or Papanicolaou smear a high-grade SIL, a cervical biopsy was performed. Absence of CIN was defined by normal Papanicolaou smear and colposcopy. High grade CIN was defined by either identification of high grade SIL on Papanicolaou smear or high grade lesion on colposcopy confirmed by CIN2-3 lesion on biopsy. Other cases were classified as low-grade CIN. HPV infection was diagnosed on presence of koilocytosis on cytological or histological specimens. RESULTS: Prevalence of CIN was significantly higher in the 128 HIV+ women than in the 102 HIV- women: 34.4% vs. 13.7% (O.R.=3.30). Among HIV+ women, 25.8% had low-grade CIN and 8.6% high-grade CIN versus 10.8% and 2.9%, respectively among the HIV- women. Prevalence of HPV infection was 50.0% among women with CIN vs. 5.8% in women without CIN (P= 10(-6)). In the multivariate analysis of the determinants of CIN, smoking more than ten pack-years and HPV infection were the only two variables associated with CIN while association with HIV infection disappeared. Among HIV+ women, the variables associated with CIN were clinical AIDS and HPV infection.

[Prognostic role of pregnancy on the course of HIV infection: a retrospective cohort study (1985-92)]. / Rôle pronostique de la grossesse sur l'évolution de l'infection par le VIH: une étude de cohorte rétrospective (1985-1992). Groupe d'épidémiologie clinique du Sida en Aquitaine.

In a hospital-based cohort study of HIV-infected patients, we compare the progression of the disease (occurrence of CDC group IV, death, decline of CD4 below 200/mm3) between 55 women with delivery and 89 matched control HIV positive women with no history of pregnancy. After a mean follow-up of three years, no significant difference was observed between the two groups even after adjustment on prognostic variables.