Impact of sampling origin on molecular detection of high-risk human papillomavirus and oncogene expression.

PURPOSE OF INVESTIGATION: The recognition of high-risk human papillomavirus (HR-HPV) as an etiological agent of cervical cancer has increased the importance of testing for HPV, and this might contribute to better risk stratification. METHODS: Eighty-eight randomly selected cervical cancer specimens including biopsies and their respective smears were used in this study. Control scrapings were obtained from ten healthy women. The presence of HPV16 and HPV18 was investigated using the technique of polymerase chain reaction (PCR) with the specific primers for the L1 region, while mRNA expression of HPV16 E6-E7 was evaluated by a reverse transcription PCR method (RT-PCR). RESULTS: The positivity for the viral genotype was influenced by the quantity of amplified DNA used. In tumor biopsies the higher positivity for HPV16 (54.5%) and HPV18 (15.9%) was obtained using 687.4 ng of DNA. At smears level solely 31.8% of HPV16 was detected using an average DNA quantity of about 157.2 ng. The revelation of HPV types depends on clinicopathologic data; HPV16 was detected more in advanced stages of squamous carcinoma (SC) samples (20% stage I, 62% Stage II and 80% stage III), while HPV18 and double infection were found exclusively at advanced stages of SC and in adenocarcinoma (AC), respectively (60%, 40% stage III SC and 80%, 20% Stage II A and C). The prevalence of HPV16 E6-E7 transcripts was evaluated at tumor biopsy with frequencies of 50%. CONCLUSION: Our data provide prospective evidence that HPV16/18L1 revelation at biopsy toward pathological types is efficient and correlates well with oncogenic transcript findings. Subtle changes in viral oncogene dynamics highlight the presence of other regulating proteins serving as additional biomarkers.

Sonographic landmarks to differentiate "false labor" and "early true labor" as a possible new application of ultrasound in labor ward.

OBJECTIVE: To evaluate discrimination of clinical parameters and ultrasound examination to differentiate "false labor" and "true labor". METHODS: In a prospective study during a period of 6 months, a total of 178 patients in term (37-41 weeks) consulting our obstetric unit for uterine contraction, were enrolled. Patients were examined separately by a midwife and a resident and separated into "true labor group" and "false labor group". The clinical characteristics of true versus false labor patients were compared. ROC curves were developed to determine an optimal cervical length and uterocervical angle for prediction of true labor. RESULTS: The prevalence of real labor was 57.3%. Patients who were in true labor had more painful and more frequent contractions. The "true labor" group had shorter cervical length and larger uterocervical angle. The optimal CL cut-off was 1.4mm with a specificity of 73% (RR 4.3, sensibility 63%, PPV 14%, NPV 95%). The optimal UCA cut off was 123° (RR 6.7, sensitivity 50%, specificity of 83%, PPV 10%, NPV 96%). The best performance was demonstrated by combined testing, yielding LHR+ that rich 13. CONCLUSION: In this study, we reported a new application of ultrasound to identify false labor and avoid unnecessary hospitalization with obstetric and adverse economic impacts.

[Oligohydramnios and fetal malformation association]. / Association oligoamnios et malformations foetales.

L'Oligaminos is sometimes discovered during echographic exploration in obstetrics. Etiology is dominated by renal malformations, obstructive myopathies and polymalformatives syndromes therapeutic interruption of pregnancy needs to be discussed in case of bilateral renal malformation.

[Hypogastric artery ligation for post-partum hemorrhage]. / Ligature bilatérale des artères hypogastriques dans la prise en charge des hémorragies du post-partum.

UNLABELLED: Post-partum hemorrhage is the leading cause of maternal mortality in Tunisia as in many other countries. In case of failure of medical measures, bilateral ligation of hypogastric arteries (BLHA) represents an interesting alternative to the hemostatic hysterectomy to preserve patients fertility. OBJECTIVE: Report our BLHA experience in the post-partum hemorrhage management. PATIENTS AND METHODS: Retrospective study conducted between January 2001 and December 2008. We collected all the patients who had undergone a BLHA in case of post-partum haemorrhage. RESULTS: Fifty-seven BLHA were carried out during the study period. The success rate was 82.45%. The procedure failed in 10 patients. Most cases were uterine atony and placenta accreta. We reported one complication: a case of perioperative ligation of the primitive iliac artery. Surgical management was successful. Magnetic resonance imaging performed on average two months after surgery had shown a complete repermeabilization in seven cases among eight. CONCLUSION: BLHA is an interesting and effective option in the management of severe post-partum hemorrhage. Technique learning is recommended especially in case of non availability of uterine artery embolization.