Clearance of high-risk human papillomavirus (HPV) DNA and PAP smear abnormalities in a cohort of women subjected to HPV screening in the New Independent States of the former Soviet Union (the NIS cohort study).

BACKGROUND: We analysed the temporal relationships of the clearance of human papillomavirus (HPV) DNA and cytological abnormalities in women participating in a screening study in three NIS countries. METHODS: The 274 patients included in this analysis were prospectively followed-up for 21.6 months (range: 0.5-42.9). All 274 women had abnormal PAP test (ASC-US or higher) and high-risk HPV-positive test (HCII) at baseline. Two groups were compared: 132 women who cleared both tests (Group 1), and 142 women who cleared either HPV or abnormal PAP test (Group 2). The first clearance during the follow-up, and the last visit clearance were modeled using life-table techniques, and the predictive factors were analysed using univariate (Kaplan-Meier) and multivariate (Cox) survival analysis. RESULTS: There was no difference in the mean clearance time for the abnormal PAP test (14.4 months; 0.7-40.5 and 12.6 months; 0.5-35.0) and high-risk HPV DNA (12.67 months; 0.6-33.5 and 10.8 months; 0.7-33.4) in Group 1 and Group 2 (Mann-Whitney: P = 0.107 and P = 0.082, respectively). Clearance times for HPV DNA and abnormal PAP test did not deviate from each other in either groups (Wilcoxon: P = 0.063 and P = 0.088). The monthly clearance rates for the abnormal PAP test are 1.32 and 1.38%, and those for the HPV DNA 1.62 and 1.61%, in Groups 1 and 2, respectively. Of the factors predicting the last visit clearance, the issues related to smoking are of particular interest. CONCLUSIONS: The clearance of high-risk HPV type and abnormal PAP test shows a close temporal relationship, the former preceding the latter, however, by an interval of 1.0-2.0 months.

Factors predicting persistence of high-risk human papillomavirus (HPV) infections in women prospectively followed-up in three New Independent States (NIS) of the former Soviet Union.

BACKGROUND: We completed an analysis of the factors predicting the persistence of high risk (HR) HPV infections in women participating in a multicenter screening trial in three NIS countries. METHODS: The 543 baseline HR HPV-positive women included in this analysis are derived from a sub-cohort of 887 women who were prospectively followed-up for a mean of 21.6 months (range: 0.5-42.9) as a part of a multi-center screening study in three NIS countries (the NIS cohort study; n = 3,187 women). Of these 543 women, 273 showed persistent HR-HPV in serial Hybrid Capture II (HCII) testing during the follow-up (Group 1), whereas 270 women cleared their infection (Group 2). These two groups were compared with their epidemiological, clinical, and virological data (HCII, PCR) to disclose the factors predicting persistent HR-HPV infection. RESULTS: Women with persistent HR-HPV infections were significantly younger (27.3 yrs) than those who cleared their infection (29.1 yrs) (p = 0.006), and their follow-up time was shorter; 14.1 and 21 months, respectively (p = 0.0001). Both variables were treated as confounders in the multivariate analyses. Of the 66 recorded epidemiological variables, only being a current smoker proved to be an independent predictor (OR 1.693; 95% CI 1.114-2.573; p=0.014). Baseline colposcopy, biopsy or Pap smear did not predict HPV persistence, whereas an incident or persistent abnormal Pap during the follow-up were independent predictors in a multivariate model (p = 0.005), together with the high viral load (HCII RLU/CO at 100 pg/ml cut-off), and HR HPV positive PCR test (p = 0.0001). When all significant variables were entered in the regression model, only the follow-up time (OR 0.950, 95% CI 0.924-0.976; p = 0.0001) and HR-HPV positive PCR (OR 4.169, 95% CI 1.741-9.987; p = 0.001), remained independent predictors. CONCLUSIONS: While several factors were related to HR-HPV persistence in univariate analysis and when adjusted for age and follow-up time as confounders, the only independent predictors in the multivariate regression model were follow-up time and HR-HPV positive PCR. Clearly more data are needed on type-specific persistence and HPV integration as its predictors.

Dermatology manpower projections.

Since an oversupply of physician specialists leads to a waste of professional resources, planning of the number of physicians may be desirable. A model projecting the future supply of dermatologists was formulated on the basis of current residency capacity, which produces about 270 dermatologists per year, and on experience regarding the average length of active clinical practice. How changes in the training capacity affect the future supply of dermatologists was also examined. The model projects an equilibrium supply of about 9,500 dermatologists, or 3.2 per 100,000 population early in the 21st century, provided the number of new graduates remains at its present level. Assuming no economic barriers to access, 2.8 to three dermatologists per 100,000 population should be adequate to meet demand. Because of many unpredictable factors, periodic reassessment of dermatology training capacity is necessary.

[Spinal subdural hematoma. Presentation of 2 cases studied with MRI]. / Hématomes sous-duraux rachidiens. Présentation de deux cas explorés en IRM.

Spinal subdural hematomas are rare. They should be considered in the diagnosis of spinal cord compression. Prompt surgical treatment, if it is performed, may lead to complete recovery of the neurological deficit. But such treatment is not always necessary because of possible spontaneous recovery. MRI appears to be the method of choice to reveal hematomas even of small size and to follow up patients after treatment.

[Magnetic resonance imaging of intraspinal hemangioblastoma]. / Imagerie par résonance magnétique des hémangioblastomes intra-rachidiens.

Magnetic resonance (MR) findings in 16 patients operated on 21 spinal cord hemangioblastomas were reviewed. Three of these patients had von Hippel-Lindau syndrome. 13 patients had Gadolinium-DTPA enhanced MR and 2 had dynamic sequences. Using Gd-DTPA makes the diagnosis of hemangioblastomas considerably easier compared to conventional non contrast MR. Findings are specific: a tumor nodule with, as a general rule, an extensive cyst formation; the nodule shows intense, earliness, homogeneous contrast enhancement as the cyst wall does not. In less typical cases, dynamic sequences may be useful in order to distinguish hemangioblastoma from other spinal cord tumor nodules. Today, MRI is the diagnostic modality of choice and angiography should not be used. MRI is also an excellent way to check the central nervous system and the visceral manifestations in a case of von Hippel-Lindau disease and to follow up the patients.

Decreased prevalence of dysplasia in high-risk population immigrants in a low-risk area for cervical cancer.

Incidence rates of cervical cancer and its precursors vary considerably, with the highest rates found in developing countries. Differences are influenced by endogenous and exogenous factors. Comparing cytologic abnormality incidence rates from a high-risk population in the original high-risk area, with those of women from this high-risk population who have immigrated to a low-risk area could give insight in the significance of endogenous versus environmental factors. Smears collected from Surinamese women attending the Surinamese screening program and smears collected from immigrant Surinamese women attending the Dutch screening program were cytologically analyzed using the Dutch microscopical coding system KOPAC. Statistical analysis was performed by using logistic regression to calculate (age-adjusted) odds ratios (ORs). The age-adjusted ORs of having dysplasia were higher for Surinamese women living in Suriname versus Surinamese immigrant women and increased with increasing P-scores: 0.77 (0.31-1.91) for borderline changes, 1.62 (0.58-4.57) for mild dysplasia, and 3.20 (1.55-6.60) for moderate to severe dysplasia/neoplasia. We conclude that fewer cases with dysplasia are present in a high-risk population that has immigrated to a low-risk area for cervical cancer than in the high-risk population continuously living in a high-risk area. This finding emphasizes the importance of environmental factors.

Risk factors and mortality among female Riga population. An autopsy study.

Neoplasms and cardiovascular diseases were the most common causes of death in an investigation of 518 autopsies of Riga females aged 20 to 59 years. The prevalence of examined risk factors in this population was as follows: Arterial hypertension: 15.2%; hypercholesterolemia: 28.1%; smoking: 42.1%; overweight: 22.4%; increased thickness of subcutaneous fat tissue: 54.0%; low physical activity: 65.4%; diabetes mellitus: 4.9%. Coronary and vascular deaths were highest in incidence among persons with arterial hypertension, overweight, and increased fat tissue thickness.

[Primary cytomegalovirus infection in pregnant women of different socioeconomic status]. / Primoinfección por citomegalovírus en embarazadas de diferente condicion socioeconomica.

Cytomegalovirus infection is the first cause of viral congenital infections. We studied the incidence of primary cytomegalovirus infection, searching for the presence of antibodies with an ELISA technique, in 939 pregnant women of a low socioeconomic level, attending a public outpatient clinic and 123 pregnant university students, attending a special outpatient clinic for students. The initially seronegative women were tested again during the second and third trimester of pregnancy to identify primary infections. The presence of cytomegalovirus congenital infection in the newborns of infected mothers was investigated isolating the virus in cell cultures from urine samples. There was a higher prevalence of infection among low socioeconomic status women (95 vs 69.9%). Two women (one student and one coming from a low socioeconomic status) had a primary infection and in the newborn of the student, a congenital cytomegalovirus infection was detected. It is concluded that women's socioeconomic condition is not a risk factor for cytomegalovirus primary infection during pregnancy.

[Genital herpes infection in Chilean female university students]. / Infección genital herpética en estudiantes universitarias Chilenas.

This article reports on the prevalence of genital herpes infection in a sample of 635 female university students who were seen at the Gynecology Center of the University of Chile Student Medical Service. Viral isolation of genital secretions yielded 18 students (2.8%) with positive results, of whom 28% were asymptomatic shedders. Of the positive cases, 61% were clinically classified as recurrent and 39% as first episodes of genital herpes. Fluorescent monoclonal antibody typing of the isolated strains revealed that 72% were herpes simplex type 2 and 28% were type 1. The results confirm the importance of type 2 virus in genital herpes infections. They also point to asymptomatic shedders as a potential source of infection, and show the importance of a history of genital herpes in the identification of this population.

Herpes simplex virus and cytomegalovirus in pregnant Chilean university students.

Virus isolation tests were performed during the first, second, and third trimesters of pregnancy on a group of 163 students who received prenatal care at the University of Chile's Student Medical and Dental Service to determine the possible existence of genital herpes or cytomegalovirus infections. Vaginal secretion samples tested for herpes simplex virus (HSV) and urine samples tested for cytomegalovirus (CMV) were inoculated onto cell cultures and examined by immunofluorescent procedures using monoclonal antibodies. HSV was detected in five subjects, only one of whom had herpetic lesions, and was identified as type 2 in all cases. Cytomegalovirus was detected in seven subjects.

[Characteristics of herpes genitalis in university women]. / Características del herpes genital en mujeres universitarias.

We analyzed 33 patients with herpes genitalis diagnosed at a student medical outpatient facility. 42% corresponded to a first herpetic infection. The HSV-1 was present in 43% of cases, the HSV-2 in the rest. Recurrence of infection was present in 39.5% of patients, 70% of them due to HSV-2. There was a relatively high rate of asymptomatic couples who were the source of primary herpetic infection.

[Herpes simplex virus and cytomegalovirus in pregnant Chilean university students]. / Virus del herpes simple y citomegalovirus en universitarias chilenas embarazadas.

Virus isolation tests were performed on a group of 163 students who received prenatal care at the Student Medical and Dental Service at the University of Chile (Santiago) during the 1st, 2nd, and 3rd trimesters of pregnancy to determine the possible existence of genital herpes infection (isolation from vaginal secretions) or cytomegalovirus infection (isolation from urine). The samples were inoculated on cell cultures and were then studied using immunofluorescence with monoclonal antibodies. The herpes simplex virus (HSV) was detected in the vaginal secretions of 5 pregnant women, only one of whom had herpes lesions; in all these cases, the virus isolated was HSV type 2. Cytomegalovirus was detected in 7 of the pregnant women.