ABSTRACT

Out of a total of 81 women who underwent hysteroscopic incision of symptomatic septate uteri during a 5-year period, 70 were analysed with respect to reproductive outcome. Division of the septum was performed with hysteroscopic scissors in 17 patients and by means of the resectoscope in 53. Pre-operative indications included infertility, repetitive pregnancy losses, abnormal uterine bleeding and intractable dysmenorrhoea. There were a total of 51 pregnancies after a mean period of 9.3 months following hysteroscopic metroplasty, of which 29 (56.8%) were carried to term, 12 (23.5%) were spontaneous abortions, and 10 (19.6%) are in progress. The post-treatment pregnancy success rate was 73%. The number of spontaneous abortions, pregnancies to term and mean time between surgery and conception was similar in both groups. There were three cases of perforation in the group of excision with hysteroscopic scissors and a case of pulmonary oedema in the group of the resectoscope. Although different advantages are provided by each technique, and more pregnancies were established using scissors, it seems that operator experience is a major consideration in performing these therapeutic hysteroscopic operations.

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Persistent infection by human papilloma virus (HPV) is considered to be the main causative agent of cervical cancer and other anogenital cancers. Of more than 30 genotypes capable of infecting the anogenital tract it is estimated that, worldwide, HPV 16 and 18 cause 70 percent of the cervical cancers. So far, more than 100 types and subtypes of HPVs have been wholly or partially sequenced. All of them, approximately 40 types, have been isolated from lesions to the lower genital tract and between 15 and 20, according to different studies, have been detected in carcinomas. According to their oncogenic risk, they are classified as low-risk HPV (LR-HPV) and high-risk HPV (HR-HPV). We must take into account that certain viral types may appear in cancerous lesions as a result of a co-infection and not be the causative etiologic agents for tumour transformation. As is logical, epidemiological studies attribute important population variations to the prevalence and cause/effect of different viral types, however, there is no doubt about the high prevalence or involvement of types 16 and 18 in high level pathologies and carcinomas in our population. The detection of HPV DNA through techniques of Molecular Biology, regardless of the method used, are based on the specificity of the complementarity among the nucleic acids. A DNA sequence has the ability to specifically hybridise with other DNAs or RNAs so specifically that at a certain temperature they only form hybrids if 100 percent of the bases are complementary. The way of detecting these hybrids, the composition of the DNA probes, and the existence or not of amplification of the signal mark the difference between the different detection techniques. The assessment of the viral load, integration, and other molecular parameters are shaping up as excellent complementary diagnoses in daily clinical practice.