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Persistence of high-risk human papilloma virus types (HR-HPV) after surgical treatment of cervical intraepithelial neoplasia (CIN) is an important factor which influences the management and the recurrence risk. In this study, we assessed the efficiency of the loop electrosurgical excision procedure (LEEP) in HR-HPV removal. Cervical samples from 31 women, diagnosed with CIN and HR-HPV, were genotyped at six months after LEEP. We assessed the influence of various risk factors on HR-HPV persistence, using univariate and multivariate analysis: age, menopausal status, parity, abortions, oral contraception, smoking, sexual partners, initial cervical smear test and histopathological results. We detected persistent infections in 7 (22.6%) patients with 16, 18, 31, 39, 51 and 66 HPV types. Univariate analysis found that age over 30 years, multiparity, use of contraception and CIN2-3 were significant factors for persistence of HR-HPV after LEEP. Multivariate analysis showed that CIN2-3 was the only significant risk factor for HPV persistence (OR=10.7). Furthermore, although not significant, parity was also retained into final equation. HR-HPV persistence is a frequent phenomenon after LEEP. We highlight the importance of glandular involvement, residual tissue and difficulties of the resection procedure in multipara. HPV genotyping is a sensitive method to follow up this group of patients, as it can identify a type specific HPV infection. In our country with the known highest mortality rate in EU countries of cervical cancer, we need an organized cervical neoplasia screening with a validated HPV genotyping test.

Iniencephaly is a rare neural tube defect, characterized by the classical triad of extreme retroflexion of the head, occipital bone defect and variable rachischisis. Its etiology is not fully understood: it might arise due to anomalies of genes controlling the planar cell polarity pathway, affecting the dorso-ventral orientation of the body axis. Risk factors include low socio-economic status and lack of folic acid supplementation. In up to 90% of cases involves female gender. We report a case diagnosed prenatally at 13 weeks by ultrasonography. It was characterized by abnormal shape of the fetus, with no distinct separation between the head and the body, extreme retroflexion of the fetal head, significant shortening of the spine, hypotelorism and holoprosencephaly. Three-dimensional (3D) ultrasound reconstruction evidenced the occiput absence and the same marked retroflexion with lordotic cervical spine, but with clear, distinct, un-fussed vertebrae. The parents opted to have an elective termination of pregnancy. Pathological examination confirmed the diagnosis, showing a perfect correlation with the ultrasound findings. The anomaly is incompatible with life, and early antenatal ultrasound diagnosis is advisable. Suggestive 3D images were helpful for illustrating these issues to the parents during prenatal counseling.

Congenital high airway obstruction syndrome (CHAOS) is a rare disorder defined as any fetal abnormality that obstructs the larynx or trachea. Most cases are sporadic with an unknown incidence. We report a case that was diagnosed prenatally at 21 gestational weeks, which showed a typical CHAOS pattern with expanded hyperechogenic lungs, inverted diaphragms, dilated trachea and ascites. There were no other fetal abnormalities and the karyotype was normal (46xy). The parents opted to have an elective termination of pregnancy. Pathological examination confirmed the diagnosis, showing infraglottic atresia (type II) and complete trachea obstruction. The disease is incompatible with life, and antenatal ultrasound diagnosis is advisable. However, few cases have been reported which managed with neonatal interventions such as ex-utero intrapartum treatment.

The human amniotic membrane (HAM) has a long history of use in surgical diagnostic. Therefore, the discoveries of cell populations from HAM, which are capable to differentiate into different skin types have been stimulating further research in characterizing this cells and their biotechnological application. Since the discovery of HAM-derived cell characteristics, the interest of big pharmaceutical industry has become more visible in application to skin grafts. In this context, we provide an overview of the recent progress and future perspectives of HAM-derived cells in skin tissue reconstruction and further biotechnological application.