[The Hemoccult II test: results of 16 years of screening tests at the Tumor Prevention Service of the City of Paris]. / Le test Hémoccult II: résultats de 16 ans de pratique dans le Service de Prévention et Dépistage des Tumeurs de la Ville de Paris.

OBJECTIVE: Colorectal cancer is a major health problem causing high mortality and short survival after diagnosis. Both the cancer itself and its precancerous lesion, the adenomatous polyp, can provoke occult bleeding. Screening programs for cancer of the colon use the Hemocult II test to detect such occult bleeding. We report the results obtained after 16 years of screening with the Hemocult II at the Paris tumor prevention center. METHODS: Since 1980, an annual Hemocult II test has been proposed to all consulting patients over the age of 40 years. Tests were self-administrated and returned to the center by mail. After rehydration, the tests were read by center nurses. RESULTS: The test was well accepted by the patients (78-90%). Over 16 years, the test led to the diagnosis of 18 cases of cancer, two-third of which were in an early stage (Dukes A) as well as 84 adenomatous polyps including 25% with signs of moderate to severe dysplasia and one case of diffuse adenomatous polyposis. Test sensitivity was 60%, with a 97% specificity and an overall (cancer and precancerous lesions) positive predictive value of 28.3%. In light of published data on the adenoma-cancer relationship, it can be estimated that 6 cancers were avoided. CONCLUSION: Hemoccult II is an easy to perform low-cost test well accepted by patients. Its use in a screening program can detect early stage precancerous and cancerous lesions of the colon.

[Intraepithelial carcinoma and invasive carcinoma of the vulva, vagina and penis in Ile-de-france. Enquete PETRI on 423 cases]. / Carcinomes intraépithéliaux et carcinomes invasifs de la vulve, du vagin et du pénis en Ile-de-France. Enquête PETRI portant sur 423 cas.

OBJECTIVE: Precancerous and invasive carcinoma of the external genitalia and of the vagina are rare tumors and their incidence is not very well known in the Paris region. The objective of this study was to evaluate the frequency of precancerous and invasive lesions of the vulva, the vagina and the penis as well as their variation according to age. METHODS: A prospective study was conducted implicating private and public pathology laboratories in Paris and the seven departments around. Four hundred and twenty three genital biopsies have been analyzed: 160 from the vulva, 151 from the vagina and 112 from the penis. RESULTS: The mean age of the patients was 45 years. The highest frequency of genital biopsies was similar for the three anatomical sites and concerned patients of 25-34 years old. intraepithelial neoplasias represented 77p. 100 of the biopsies (32p. 100 of low grade and 45p. 100 of high grade), invasive squamous carcinoma and adenocarcinoma represented 21p. 100 and 2p. 100 of cases, respectively. The mean age of the patients with low grade vulvar intraepithelial neoplasia, low grade vaginal intraepithelial neoplasia and low grade penile intraepithelial were 34, 40 and 33 years old, respectively. An interval of three to seven years separates the mean age of low grade intraepithelial neoplasia from the mean age of high grade. High grade intraepithelial neoplasia present a peak of frequency in the same class of age for the three localizations (25-34 years) and the risk of developing a high grade intraepithelial neoplasia of the external genital was higher between 25 and 35 years and between 35-45 years of the vagina. The mean age of invasive vulvar carcinoma, vagina carcinoma and penile carcinoma was 62, 59 and 68 years old, respectively. CONCLUSIONS: The correlation between the development of intraepithelial neoplasia of the vulva and the penis supposes a common aetiologic factor in the majority of the cases. The diagnosis of a intraepithelial neoplasia implies a clinical, colposcopic and follow-up of the entire genital area.

[Genital herpes simplex virus infection among men screened for genital papillomavirus]. / L'infection génitale par les herpès simplex virus parmi des hommes consultant pour un dépistage des papillomavirus génitaux.

OBJECTIVE: Our aim was to assess the frequency of herpetic genital infection (HSV) among men attending a human papillomavirus (HPV) screening centre. Clinical screening of a herpetic lesion was completed with biological detection of HSV by cell culture and by polymerase chain reaction (PCR). We also evaluated the role of the male viral factor on the female partners. METHOD: We performed a genital examination by colposcopy of 135 men whose female partners presented an HPV genital infection. The HPV lesions detected underwent biopsy by Southern blot viral analysis. The lesions which clinically appeared to be caused by HSV were removed for HSV detection and typing by cell culture and by PCR. Sperm was collected for viral detection by cell culture and PCR was collected for viral detection by cell culture and PCR from patients presenting a herpetic type urethral symptomatology. RESULTS: Peniscopy detected HPV lesions in 46 p. 100 of the men, in 88 p. 100 of cases in the balano-preputial zone and in 82 p. 100 of cases their morphology was exophytic. The other areas were in 14.5 p. 100 of cases urethral and 9 p. 100 anal. We detected a dysplasic lesion in 6 p. 100 of cases. In 74 p. 100 of cases molecular hybridization by Southern detected 6/11/42 type HPV and in 6.4 p. 100 of cases HPV 16. Clinical examination revealed the presence of genital herpetic infection in 15.5 p. 100 of cases, of these 76 p. 100 were preputial and 24 p. 100 meato-urethral. PCR detected HSV-2 in 88 p. 100 of the preputial lesions and in 86 p. 100 of the spermatic ejaculates from the meato-urethral lesions. The chi 2 test showed that no link exists between a herpetic genital infection and the presence of an HPV lesion, but that the risk is greater (OR = 2.15; IC 95 p. 100 = 0.84-5.49). We also observed that 50 p. 100 of the female partners of men with both HPV+HSV infections had high grade cervical lesions. CONCLUSION: This study shows that clinical examination in an HPV screening centre enabled detection of clinical HSV in 15.5 p. 100 of cases as opposed to 17 p. 100 biologically. Thus the good clinical-virological correlation shows that clinical criteria remain the principal elements for detecting viral genital infections, it therefore appears advantageous to only use the new HSV identification techniques for targeted detection. Also, herpetic genital infection is independent of human papillomavirus infection. When screening for HPV, herpetic genital infection should be taken into account as we have observed that the female partners of men with both HPV + HSV are at greater risk of presenting high grade cervical lesions.

[Risk factors for tumors of the bladder. Epidemiological study of 701 patients in Ile-de-France]. / Facteurs de risque des tumeurs de vessie. Etude épidémiologique chez 701 sujets en Ile-de-France. Groupe Cancers Vessie de PETRI.

The authors present the results of an investigation conducted, under the aegis of the PETRI association, on 701 patients living in the Paris region who, over a 1-year period, had asked the medical advisers of the Social Security Sickness Benefits department to dispense them from paying their portion of the cost of treatment on the ground that they had cancer of the bladder*. The purposes of the investigation were to obtain accurate data concerning the role played by tobacco and alcohol abuse in bladder cancer and to look for possible occupational exposures. The smoking and drinking habits of 636 patients could be analyzed: 89 percent of the men were, or had been, smokers with an average consumption of 33 packs per annum, and with a frequent overconsumption of alcoholic drinks. The professional cursus of 665 patients (31 percent active, 64 percent retired) could be established. The study confirmed that tobacco smoking and alcohol abuse, as well as certain occupational factors, play a role in the development of bladder cancer. Some professional sectors, such as the plastic industry or the hide and leather work, were better represented among these patients than would have been expected from their distribution in the active population. Surveillance of the population exposed by industrial doctors, and follow-up of people who have retired from some sectors of activity are as essential as anti-smoking campaigns.

[Control of laser treatment of 58 cervical condylomas: cyto-colposcopic correlations at 3, 6 and 12 months]. / Contrôle du traitement laser de 58 condylomes cervicaux: corrélations cyto-colposcopiques à 3, 6 et 12 mois.

Cytologic and colposcopic findings 3, 6 and 12 months after laser treatment of cervical condyloma or intraepithelial neoplasia have been studied. Cytologic features of Papillomavirus infection were evidenced in 28 cases by cytology but only in 12 by colposcopy. The cytologic most frequent feature was parakeratosis without clear koilocytosis. One year after laser treatment, cytology and colposcopy showed features of papillomavirus infection in only seven cases. Thus, spontaneous regression of colposcopically detected lesions occurred in five cases. In 16 cases, the parakeratosis detected on the first smear seem to represent healing and tissue maturation more than the persistence of HPV infection.

[Combination vindesine, cyclophosphamide, cis-platinum and CCNU in esophageal epidermoid cancer. Preliminary analysis of 64 cases]. / Association vindésine, cyclophosphamide, cis-platinum et CCNU dans les cancers epidermoïdes de l'oesophage. Analyse préliminaire de 64 cas.

We have treated 64 patients with esophageal squamous cell carcinoma using a combination of Vindesine 1.4 mg/m2 on day 1-2, Cyclophosphamide 200 mg/m2 on day 2-3-4, Cis-Platin 100 mg/m2 on day 3 and CCNU. 28 of the 37 patients considered to be inoperable were evaluable. We observed three complete responses and three partial responses in this group (overall response rate 21,5%). Twenty seven patients considered to be operable received the same chemotherapy without CCNU, owing to the risk of thrombopenia. 23 of these patients were evaluable in whom we observed 35% partial responses and no complete responses. No severe toxicity related to the chemotherapy protocol was observed. The mediocre results among the group of inoperable patients suggest that other chemotherapy protocols need to be tested. On the other hand, in the group of operable patients, the preliminary results encourage us to continue this study.

[Retrospective study of 88 cases of cancer of the cervical esophagus and definition of a new therapeutic approach]. / Etude rétrospective de 88 cas de cancers de l'oesophage cervical et définition d'une nouvelle approche thérapeutique.

Eighty-eight cases of cancers of the cervical esophagus were treated at the Institut Gustave-Roussy (France) between 1968 and 1980. They included 67 epitheliomas of the esophageal opening excluding those of the hypopharynx extending into the esophagus, and 21 epitheliomas of the actual cervical portion of the esophagus. Whenever possible, basic therapy was by radiotherapy (64 cases). There were no survivors after 2 years, possible explanations for this poor result being the selection criteria for treatment, the choice of radiotherapy as basic treatment, and the doses employed. A new therapeutic approach is suggested following a pathological study and an analysis of the different therapeutic possibilities available. Pre-operative chemotherapy is followed by total laryngopharyngectomy with total esophagectomy without opening of the thorax, performed under certain well defined conditions. Continuity is reestablished by gastropharyngostomy and postoperative radiotherapy is applied systematically. This therapeutic approach involving major surgery is applicable only for selected patients, others having to be treated by combined radiotherapy and chemotherapy alone.