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Biomedical subjects

R Barrasso

Publications and source records attributed to R Barrasso.

At least 19 recordsLinked to original sources
PubMed2000

European course on HPV associated pathology: guidelines for primary care physicians for the diagnosis and management of anogenital warts.

The European Course on HPV Associated Pathology (ECHPV) was founded in 1990 by a group of clinicians, pathologists, and virologists to teach important principles for the practice and management of human papillomavirus (HPV) disease to gynaecologists, dermatologists, and other medical disciplines. These guidelines are intended to assist the practice of primary care physicians for diagnosis and treatment of anogenital warts.

Adjuvants, Immunologic↗
PubMed1998

Comparison of clinical, histological, and virological symptoms of HPV in HIV-1 infected men and immunocompetent subjects.

OBJECTIVE: We assessed the clinical, histological, and virological features of anogenital human papillomavirus (HPV) infection, according to their immune status in HIV-1 infected men, referred for an anogenital examination or treatment, in comparison with immunocompetent patients. METHODS: The study population comprised 33 HIV-1 infected heterosexual or homosexual men and 38 HIV negative men seen in a screening and treatment centre for anogenital HPV infections. All patients were examined with a colposcope. Biopsies were carried out on all subjects with anogenital lesions for histological studies and HPV detection by Southern blot. RESULTS: The HIV infected patients had a balanopreputial HPV infection in 70%, anal in 30%, and urethral in 37%, while HIV negative patients had balanopreputial lesion in 72%, anal in 26%, and urethral in 16%. Diffuse anogenital lesions were present in 33% of the HIV infected cases and in 10.5% of HIV negative cases (p < 0.02). Among the HIV infected patients, the genital HPV lesions were condylomatous in 67.5% of the cases and dysplastic in 57%. HIV negative patients had condylomatous lesions in 86% of the cases and dysplasic in 14%. The condylomatous lesions of HIV infected patients had a low grade malignant histological aspect in 36% of the cases and high grade histological criteria were found in 22% of the dysplasias. Oncogenic HPVs were detected more frequently in HIV infected patients (35% v 12%) and more than one HPV type was found in 21.5% of cases. Neither the anogenital diffusion of the HPV lesions nor their morphological, histological, and virological features differed significantly in patient with CD4 cell counts > or < 200 x 10(6)/l. In contrast, patients with CD4 cell counts < 50 x 10(6)/l had a higher risk of several types of HPVs and of developing a diffuse anogenital infection. CONCLUSION: HIV-1 infected patients had an increased frequency of high grade anogenital dysplastic lesions and a higher frequency of HPV infection with multiple and diffuse sites of involvement. These characteristics of HPV infection were independent of the patients' immune status up to CD4 cell counts > 50 x 10(6)/l but showed an increased risk when the CD4 cell count was < 50 x 10(6)/l. The higher frequency of diffuse anogenital infections among HIV infected men calls for rapid treatment, laser or surgery, given the association of histological features of intraepithelial neoplasia and the presence of multiple HPV infection sites which may be the consequence of immune disturbances, most of which are transmissible potentially oncogenic HPVs.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Effectiveness of local anesthesia using EMLA cream for laser treatment of cervical and vulvar lesions].

The efficacy of the anesthesia by the Emla cream (a mixture of lydocaine and prylocaine) has been tested on the cervix uteri and the vulva before laser treatment of warts and intraepithelial neoplasia. Five of the six women treated for vulvar warts did not feel any pain during laser treatment after the application of the cream. On the cervix, the pain was evaluated on a median of 9 on a visual scale going from 0 to 100, compared to a median of 25 for women treated without local anesthesia. The efficacy of local anesthesia was best after 4 minutes. The local anesthesia by the Emla cream seems to constitute a real progress in the patient's tolerance of local destructive treatment of cervical and vulvar warts and intraepithelial neoplasia.

Anesthetics, Combined↗
PubMed1996

HPV infection and disease in men.

Penile HPV infection and disease are very common in sexually active men, and may be manifest in many forms. Treatment of clinically detectable lesions is advisable not only to relieve symptoms but also to prevent the spread of HPV infection to new sexual partners. Treatment of subclinical disease is more controversial but also may be advisable in some cases given the evidence that these lesions may also harbor infectious virus. In addition, subclinical disease may demonstrate intraepithelial neoplasia, which if left untreated may progress to invasive cancer in a small number of cases. Anal HPV infection and ASIL are very common in high-risk homosexual and bisexual men, particularly among those who are HIV positive. Parallels with cervical HPV infection and disease suggest that anal HSIL may be precancerous, and indeed anal cancer may be as common or more common in this high-risk group as cervical cancer is in women. Further studies are needed to elucidate the natural history of ASIL, the role of immunosuppression in progression to invasive cancer, optimal diagnostic methods, and optimal treatment regimens. Like cervical cancer, anal cancer may be a preventable disease, and implementation of a well-targeted screening program similar to that in place for cervical disease should be considered in the future when appropriate supporting data become available.

Adult↗
PubMed1994

Penile intraepithelial neoplasia. Specific clinical features correlate with histologic and virologic findings.

BACKGROUND: To evaluate the existence of the morphologic features specific for penile intraepithelial neoplasia (PIN), 1000 male sexual partners of women with genital condyloma or intraepithelial neoplasia were studied. METHODS: Ninety-two patients who presented with lesions suggesting intraepithelial neoplasia (pigmented or leukoplastic papules, keratinized condylomata, or erythroplastic macules) underwent biopsy for histologic and virologic studies. RESULTS: Histologic results showed penile intraepithelial neoplasia in 93% of the specimens. Human papillomavirus (HPV) DNA from potentially oncogenic papillomaviruses was detected in 75% of patients with Grade I PIN, in 93% of patients with Grade II PIN, and in all patients with Grade III PIN: Uncircumcised and circumcised men showed the same rate (52% vs. 45%; odds ratio [OR] = 1.3; 95% confidence interval, 0.97-1.73) of HPV-associated lesions, whereas the rate of PIN was significantly higher in uncircumcised men than in circumcised men (10% vs. 6%; OR = 1.77; 95% confidence interval, 1.02-3.07). The mean age of patients with Grade III PIN was 7 years older then the mean age of patients with Grade I PIN, which suggests a step progression similar to that of cervical intraepithelial neoplasia. CONCLUSION: Morphology seems to be a specific-enough indicator of PIN. More data are needed to determine whether treatment of PIN may contribute to preventing cervical or penile cancer. If so, the morphologic criteria here described will be clinically useful.

Adult↗
PubMed1993

[Outpatient excision of low grade cervical intraepithelial lesions using loop diathermy].

Twenty five years after the introduction of outpatient treatment for cervical precancers, several cases of invasive cancer after laser, cryotherapy or electrocautery have been described. As a consequence, the diathermy loop excision has recently been proposed for the treatment of cervical intraepithelial neoplasia. The new generators seem to assure a high quality of cut and allow the histological analysis of all the lesional tissue excised as deep as the laser vaporisation usually goes (7 mm). We have tested this treatment on a series of CIN I on an outpatient basis and our results confirm that loop excision can replace destructive treatments for CIN I. As for high grade lesions, we still think that laser conisation under general anesthesia remains the best choice.

Ambulatory Care↗
PubMed1992

Human papillomaviruses associated with cervical intraepithelial neoplasia. Great diversity and distinct distribution in low- and high-grade lesions.

All together, 30 genital human papillomavirus (HPV) types have been characterized so far. To evaluate the importance of HPV diversity in associated cervical diseases, we analyzed 188 biopsy specimens obtained from patients with a recent diagnosis of cervical HPV infection or intraepithelial neoplasia (CIN). Of these 188 specimens, 116 were classified as low-grade CIN (48 cases), high-grade CIN (53 cases), condylomata acuminata (10 cases), flat condylomas (five cases). Seventy-two specimens were considered nondiagnostic. Using probes specific for 18 genital HPV types, HPV DNA sequences were detected by Southern blot hybridization in 100 lesions and 21 nondiagnostic specimens. When further analyzed by the polymerase chain reaction, eight HPV-negative biopsy specimens, four CIN, and four nondiagnostic specimens were positive. Of the 129 positive biopsy specimens, 92 contained at least one of 18 known HPV types and 37 HPV that have not yet been identified. Nine specimens had more than one type. Thirteen HPV types were identified in CIN. The detection rate of HPV 16 increased from 21% in low-grade CIN to 57% in high-grade CIN. HPV 18 was detected in only 3% of CIN; HPV 31, 33, and 35 were found in 8%. HPV 30, 39, 45, 51, 52, 56, 58, and 61 were detected in 44% of low-grade CIN but in only 8% of high-grade CIN. Unidentified HPV were detected in about 25% of low-grade and high-grade CIN. Fifty-seven CIN positive for at least one HPV type were further analyzed by in situ hybridization. Thirty-five (65%) biopsy specimens were positive, including 21 of 24 low-grade CIN and 14 of 33 high-grade CIN. Ten of the 13 previously identified HPV types were detected. Thus, CIN represents an heterogeneous disease from a virologic viewpoint. This fact could explain their variable clinical evolution.

Adolescent↗
PubMed1992

[Male genital examination: the usefulness of penis endoscopy and the acetic acid test for the detection of papillomavirus lesions].

This study was based on 2,400 genital examinations performed by means of the acetic acid test looking for human papillomavirus (HPV) lesions in the male partners of women with HPV genital lesions. These peniscopies demonstrated HPV lesions in 56% of the men examined. In 109 cases, histological and virological examination revealed that 30% of them had areas of intraepithelial neoplasia of the penis, associated with potentially oncogenic papillomavirus infection. The value of this examination is to detect HPV lesions and, in particular, dysplastic lesions. The treatment of these lesions appears to allow a reduction in the incidence of recurrence of HPV lesions in women after treatment.

Acetates↗
PubMed1992

Colposcopic diagnosis of HPV cervical lesions.

The colposcopic criteria for abnormal epithelium are leukoplakia, a white area detected after the application of acetic acid or iodine-negative areas not reacting to the acetic acid test. However, white epithelium and iodine-negative areas are not specific for abnormal tissue, condyloma or intraepithelial neoplasia. The lack of specificity of colposcopic findings has motivated the distinction between minor and major grade abnormalities in the recently proposed new colposcopic terminology. Metaplasia and dysplasia cannot be distinguished by colposcopy. All criteria proposed so far lack specificity and reproducibility. Thus, it is at present considered that colposcopy is not a diagnostic method, but an investigative technique that allows the evaluation of the extent of the lesion and localization of the squamo-columnar junction. As for the distinction between condyloma and high-grade intraepithelial neoplasia, all criteria proposed so far also lack reproducibility. Moreover, condyloma is often found at the periphery of high-grade CIN, rendering such a distinction meaningless. The only features specific of HPV infection without dysplasia are condyloma acuminatum and, to a lesser extent, non-acetowhite microcapillary surfaces. Finally, it has been shown that there is no colposcopic sign specific of HPV types.

Carcinoma↗
PubMed1992

HPV-related genital lesions in men.

Screening of the asymptomatic male partners of women with genital condyloma or intraepithelial neoplasia has shown that about 50% of the individuals examined present genital HPV-associated lesions. Half to two thirds of these lesions are clinically invisible and are detected only after the acetic acid test. Histological studies have shown that 20% of male partners of women with high-grade intraepithelial neoplasia present lesions histologically defined as high-grade intraepithelial neoplasia. Couples in which both partners present lesions of intraepithelial neoplasia are infected by the same potentially oncogenic HPV type in at least 50% of cases. Also, 50% of subclinical lesions showing only minimal histological changes (acanthosis and papillomatosis, without clear koilocytosis) contain HPV DNA, mostly type 42. In situ hybridization of such lesions indicate HPV-positivity, suggesting that these lesions may be infectious. Cytology does not seem to be specific enough to detect HPV infection in males. Moreover, virological studies do not confirm the hypothesis of an urethral reservoir of HPV. Morphology allows the detection of HPV-associated genital lesions in males. Current treatment protocols allow a 95% cure rate by easily applicable outpatient treatment modalities.

Female↗