Prise en charge des lésions pré-néoplasiques du col utérin au CHU Morvan de Brest de 1995 à 2004

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Screening for Neuropathic Pain, Anxiety and Other Associated Chronic Pain Conditions in Vulvodynia: A Pilot Study

International audienceVulvodynia has been defined by the International Society for the Study of Vulvovaginal Diseases (ISSVD) as vulvar discomfort, which is most often described as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder (1). Much remains to be understood regarding the patho genesis, natural history, and management of this distressing condition. As postulated for many chronic pain syndromes, the involvement of both peripheral and central sensitization mechanisms in the pathogenesis of vulvodynia has been suggested (2, 3). The characteristics of the pain experienced by patients with vulvodynia suggests the involvement of a neuropathic component in vulvodynia; this includes: hyperalgesia, paraesthesia, dysesthesia and allodynia. In addition, the ineffectiveness of common pain-killers, the effectiveness of certain anticonvulsants (4), anti-depressants and transcutaneous electrical nerve stimulation (TENS) (5) are occasionally reported in association with vulvodynia. The primary objective of the present study was to generate further evidence in support of the existence of a neuropathic component underlying the pathogenesis of vulvodynia. An additional aim was to determine the presence of anxiety, depression and other chronic pain conditions in patients with vulvodynia

Human Papillomavirus Quantification in Urine and Cervical Samples by Using the Mx4000 and LightCycler General Real-Time PCR Systems

During the last decade, growing efforts have focused on human papillomavirus (HPV) detection using liquid hybridization, conventional PCR, and real-time PCR-based methods to increase the overall proportion of patients participating in cervical cancer screening procedures. We proposed a new general HPV DNA real-time PCR on the Mx4000 (Stratagene) and LightCycler (Roche Diagnostics) systems usable for both cervical scrape specimens and urine samples. A linear range was obtained from 5 DNA copies to 8 log(10) DNA copies/ml, and intra- and interassay variations were between 1.8 and 4%. Cervical carcinoma and HPV DNA screening was performed in 333 individual women referred for gynecological examination at the university hospitals of Angers and Brest and enrolled in the PapU study. Among cervical specimens (n = 333), 45% were positive for HPV DNA, with a mean viral load at 5.00 log/ml (± 1.73). Among urine samples (n = 177), 37% were positive with a significant 50-fold-lower mean viral load (3.77 ± 1.32 log/ml; P < 0.0001). Kappa agreement for HPV DNA between cervical and urine specimens was excellent (93%). Thus, we developed a highly sensitive and quantitative general HPV DNA real-time PCR method that allows mass screening of patients with HPV infection. The ongoing longitudinal and prospective multicenter PapU study should give us the opportunity to validate this method adapted to HPV DNA screening in urine samples in a larger population

Interest of Human Papillomavirus DNA quantification and genotyping in paired cervical and urine samples to detect cervical lesions

International audienceBackgroundCervical cancer is caused by persistent infection with high-risk human papillomavirus (HR-HPV). Conventional human papillomavirus (HPV) testing requires cervical sampling. However, vaginal and urine self-sampling methods are more acceptable for patients and result in increased participation when they are available in screening programs. In this context, we have developed a non-invasive screening method via the detection of HPV DNA in urine samples.PurposeTo compare HPV viral loads and genotypes in paired cervical and urine samples, and to assess correlation between virological and cytological results in women seeking gynecological consultation.MethodsPaired urine and cervical specimens were collected and analyzed from 230 of 245 women participating in the previously described prospective PapU study. HPV DNA detection and quantification were performed using a real-time PCR method with short fragment PCR primers. Genotyping was carried out using the INNO-LiPA HPV genotyping assay.ResultsThe prevalence of HPV in the 230 paired urine and cervical smear samples was 42 and 49&nbsp;%, respectively. Overall agreement for HPV positivity and negativity between the paired samples was 90&nbsp;% (κ&nbsp;=&nbsp;0.80). High HPV viral load in both cervical and urine samples was associated with cytological abnormalities. HPV-positive women were mostly infected with HR-HPV types. The agreement between high- and low-risk HPV (LR-HPV) detection in both samples was 97&nbsp;% (κ&nbsp;=&nbsp;0.95 for HR-HPV and κ&nbsp;=&nbsp;0.97 for LR-HPV).ConclusionsHigh concordance rates for HPV-DNA quantification and high/low-risk HPV genotyping in paired urine/cervical samples suggest that urinary HPV DNA testing could be useful for cervical lesion screening.</p

Interest of Human Papillomavirus DNA quantification and genotyping in paired cervical and urine samples to detect cervical lesions

International audienceBackgroundCervical cancer is caused by persistent infection with high-risk human papillomavirus (HR-HPV). Conventional human papillomavirus (HPV) testing requires cervical sampling. However, vaginal and urine self-sampling methods are more acceptable for patients and result in increased participation when they are available in screening programs. In this context, we have developed a non-invasive screening method via the detection of HPV DNA in urine samples.PurposeTo compare HPV viral loads and genotypes in paired cervical and urine samples, and to assess correlation between virological and cytological results in women seeking gynecological consultation.MethodsPaired urine and cervical specimens were collected and analyzed from 230 of 245 women participating in the previously described prospective PapU study. HPV DNA detection and quantification were performed using a real-time PCR method with short fragment PCR primers. Genotyping was carried out using the INNO-LiPA HPV genotyping assay.ResultsThe prevalence of HPV in the 230 paired urine and cervical smear samples was 42 and 49&nbsp;%, respectively. Overall agreement for HPV positivity and negativity between the paired samples was 90&nbsp;% (κ&nbsp;=&nbsp;0.80). High HPV viral load in both cervical and urine samples was associated with cytological abnormalities. HPV-positive women were mostly infected with HR-HPV types. The agreement between high- and low-risk HPV (LR-HPV) detection in both samples was 97&nbsp;% (κ&nbsp;=&nbsp;0.95 for HR-HPV and κ&nbsp;=&nbsp;0.97 for LR-HPV).ConclusionsHigh concordance rates for HPV-DNA quantification and high/low-risk HPV genotyping in paired urine/cervical samples suggest that urinary HPV DNA testing could be useful for cervical lesion screening.</p