RESUMEN
Since human papillomavirus (HPV) is the central causal factor in cervical cancer, understanding the epidemiology of this infection constitutes an important step towards development of strategies for prevention. Six hundred and fifty seven cervical samples were tested for HPV using PCR with consensus primers (MY09/MY11), by genotyping (restriction and sequencing analyses) and by cervical cytology, from women who attended a Health Examination Center of the French social security. Women with no cervical smear as well as women with cytological abnormalities within the last 3 years were recruited. HPV DNA was detected in 7.3% of the women (5.3% for high-risk, 2.4% for low-risk, and 0.5% for unknown risk types) including 6 (0.9%) mixed infections. Fifteen different genotypes were detected, of which genotypes 16 (22.2%), 58 (13.0%), 18 (11.1%), 30 (9.2%), and 33 (9.2%) were the most prevalent. In age group 17-25 years, we found the highest frequencies for both any (22.1%) and high-risk (14.7%) HPV, and prevalences gradually decreased with age. 5.2% of low-grade squamous intraepithelial lesion, 0.3% of high-grade squamous intraepithelial lesion, and 1.2% of atypical squamous cells of undetermined significance were found. The frequencies of high risk and all HPV types were significantly higher in squamous intraepithelial lesions than in those with normal and reactive/reparative changes (P < 0.0001). The prevalence of high-risk HPV in the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion group (28.6%) was significantly higher than in the normal and reactive/reparative changes groups (3.4%) (P < 0.0001). HPV detection was associated with younger age, single marital and non-pregnant status (P < 0.0001), premenopausal status (P = 0.0004), and contraception (P = 0.0008). Marital status (OR 4.5; 95% CI = 2.3-9.0) and tobacco consumption (OR 3.0; 95% CI = 1.6-5.7) were predictive independent factors of HPV infection. The French system of Health Examination Centers might be of interest for following women regularly, especially those with a low socioeconomic status.
Asunto(s)
Cuello del Útero/patología , Cuello del Útero/virología , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anticoncepción , Dermatoglifia del ADN , ADN Viral/análisis , ADN Viral/química , ADN Viral/aislamiento & purificación , Femenino , Francia/epidemiología , Genotipo , Humanos , Estado Civil , Ciclo Menstrual , Persona de Mediana Edad , Neoplasias de Células Escamosas/patología , Neoplasias de Células Escamosas/virología , Polimorfismo de Longitud del Fragmento de Restricción , Embarazo , Factores de Riesgo , Análisis de Secuencia de ADN , Fumar , Displasia del Cuello del Útero/patología , Displasia del Cuello del Útero/virologíaRESUMEN
Chronic esophagitis induced by radiation therapy (CRE) for carcinoma of the oropharynx and larynx, and involving an initially normal esophagus, is poorly known, and often confused with a locally recurrent malignancy. By reporting 8 consecutive cases, the aim of this study is to contribute to proving that cervical CRE does indeed exist. Eight men, aged 58 to 76 years, developed complete aphagia (7 cases) or severe dysphagia (1 case), 2 to 56 months (median 8.5 months) after radiation therapy for carcinoma of the laryngopharyngeal area. In 5 patients, the primary tumour and/or chains of cervical lymph nodes were removed before radiation therapy; in the 8 patients, the esophagus was endoscopically free of disease. The total dose of radiation exceeded 60 grays in 6 patients. Although they were initially considered as suffering from a locally recurrent malignancy on a clinical basis, none of the 8 patients had patent signs (either endoscopic or histologic) of recurrence. In each case a severe lesion of the cervical esophagus was documented (stenosis 7 cases, giant ulceration 1 case): the diagnosis of CRE was based on endoscopic, histological, and evolutive criteria. Six patients were treated by prolonged nutritional support (via enteral route, 5 cases; parenteral route, 1 case); endoscopic dilatations were used as a single treatment or in association with nutritional support in 4 cases. Three patients died of CRE-induced regional complications; post mortem examination, performed in 2 cases, confirmed CRE without evidence of locally recurrent malignancy.(ABSTRACT TRUNCATED AT 250 WORDS)