200 research outputs found
Pattern of CIN recurrence following laser ablation treatment: long-term follow-up
No full textChew GK, Jandial L, Paraskevaidis E, Kitchener HC. Pattern of CIN recurrence following laser ablation treatment: Long-term follow-up. Our objective was to study the long-term patern of recurrence of cervical intraepithelial neoplasia (CIN) and development of cervical carcinoma in patients who had been treated with laser ablative treatment. The study design consisted of a retrospective analysis of the case records of 2130 patients who received laser ablation treatment for CIN lesions from 1980-1988, with the years 1980 and 1988 inclusive. All of the 2130 women in the cohort have had at least seven years of follow-up. Of the treated population, 79% remain under regular cytological follow-up at the regional laboratory. Nine percent required further treatment, 52% of this within the first year of treatment, 19% within the second year, 4% in the third, 5% in the fourth and fifth years, and 15% over the next five years. These lesions were detected up to ten years after the initial treatment. No recurrent lesions have yet been detected after ten years, and 0.2% of the cohort have developed cervical carcinoma. Long-term follow-up has demonstrated a continuing incidence of recurrent CIN up to ten years after initial treatment. This emphasizes the need for adherence to follow-up protocol if the incidence of cervical carcinoma post-treatment is to be reduced. The data suggest that annual follow-up for 10 years may be advisable to reduce the risk of post-treatment invasive disease.Int J Gynecol Cance
"It's a can of worms": understanding primary care practitioners' behaviours in relation to HPV using the Theoretical Domains Framework
No full textBackground: The relationship between infection with high-risk human papillomavirus (HPV) and cervical cancer is transforming cervical cancer prevention. HPV tests and vaccinations have recently become available. In Ireland, as elsewhere, primary care practitioners play a key role in prevention. ATHENS (A Trial of HPV Education and Support) aims to develop a theorybased intervention to support primary care practitioners in their HPV-related practice. This study, the first step in the intervention development process, aimed to: identify HPV-related clinical behaviours that the intervention will target; clarify general practitioners’ (GPs’) and practice nurses’ roles and responsibilities; and determine factors that potentially influence clinical behaviour. A secondary objective was to informally assess the utility of the Theoretical Domains Framework (TDF) in understanding clinical behaviours in an area with an evolving evidence-base.
Methods: In-depth semi-structured telephone interviews were conducted with GPs and practice nurses. The topic guide, which contained open questions and HPV-related clinical scenarios, was developed through literature review and clinical experience. Interview transcripts were content-analysed using the TDF as the coding framework.
Results: 19 GPs and 14 practice nurses were interviewed. The major HPV-related clinical behaviours were: initiating a discussion about HPV infection with female patients; offering/recommending HPV vaccination to appropriate patients; and answering patients’ questions about HPV testing. While the responsibility for taking smears was considered a female role, both male and female practitioners dealt with HPV-related issues. All 12 theoretical domains arose in relation to HPV infection; the domains judged to be most important were: knowledge, emotion, social influences, beliefs about capabilities and beliefs about consequences. Eleven domains emerged in relation to HPV vaccination, with beliefs about consequences, social influences, knowledge and environmental context and resources judged to be the most important. Nine domains were relevant to HPV testing, with knowledge and beliefs about capabilities judged to be the most important.
Conclusions: The findings confirm the need for an intervention to support primary care practitioners around HPV and suggest it should target a range of theoretical domains. The TDF proved valuable in analysing qualitative data collected using a topic guide not specifically designed to capture TDF domains and understanding clinical behaviours in an area with an evolving evidence-base
The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy-related morbidity
No full textPlease cite this paper as: Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy-related morbidity. BJOG 2012; DOI: 10.1111/j.1471-0528.2011.03252.x. Objective The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL). Design A retrospective observational study. Setting University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH). Population Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH. Methods Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student's t-test, Mann-Whitney U-test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data. Main outcome measures Gestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation). Results Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three-fold increase in the risk of PTL if the excision volume exceeded 6 cm(3) (RR = 3.00; 95% CI 1.45-5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27-7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL. Conclusions This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm(3) carry a three times greater risk for PTL.BJO
Trial protocol OPPTIMUM : does progesterone prophylaxis for the prevention of preterm labour improve outcome?
No full textBackground
Preterm birth is a global problem, with a prevalence of 8 to 12% depending on location. Several large trials and systematic reviews have shown progestogens to be effective in preventing or delaying preterm birth in selected high risk women with a singleton pregnancy (including those with a short cervix or previous preterm birth). Although an improvement in short term neonatal outcomes has been shown in some trials these have not consistently been confirmed in meta-analyses. Additionally data on longer term outcomes is limited to a single trial where no difference in outcomes was demonstrated at four years of age of the child, despite those in the “progesterone” group having a lower incidence of preterm birth.
Methods/Design
The OPPTIMUM study is a double blind randomized placebo controlled trial to determine whether progesterone prophylaxis to prevent preterm birth has long term neonatal or infant benefit. Specifically it will study whether, in women with singleton pregnancy and at high risk of preterm labour, prophylactic vaginal natural progesterone, 200 mg daily from 22 – 34 weeks gestation, compared to placebo, improves obstetric outcome by lengthening pregnancy thus reducing the incidence of preterm delivery (before 34 weeks), improves neonatal outcome by reducing a composite of death and major morbidity, and leads to improved childhood cognitive and neurosensory outcomes at two years of age. Recruitment began in 2009 and is scheduled to close in Spring 2013. As of May 2012, over 800 women had been randomized in 60 sites.
Discussion
OPPTIMUM will provide further evidence on the effectiveness of vaginal progesterone for prevention of preterm birth and improvement of neonatal outcomes in selected groups of women with singleton pregnancy at high risk of preterm birth. Additionally it will determine whether any reduction in the incidence of preterm birth is accompanied by improved childhood outcome
Aggressive angiomyxoma of the vagina: a case report and review of the literature
No full textAggressive angiomyxoma (AA) is a rare mesenchymal tumor of the lower pelvis and genital region, characterized by local infiltration and frequent, even multiple recurrences. In the present paper a case of a small-sized AA of the vagina, in a 55-year-old woman is reported. We describe the histological appearance and the immunohistochemical phenotype of this tumor and discuss its differential diagnosis from other mesenchymal lesions occurring in the pelvic and genital region. Furthermore, we attempt to enlighten the possible mechanisms that govern the pathogenesis and the biological behavior of this "mysterious" neoplasm.Eur J Gynaecol Onco
Giant right ventricular fibroma co-existing atrial septal defect in a 15 year old girl
No full textThe most common benign cardiac tumours are the myxomas, the rhabdomyomas, and the fibromas, with the latter 2 variants being the most common tumours encountered in children. The size and location of tumours within the heart create a variety of clinical findings, such as murmurs, chest pain, tachyarrythmias, and congestive cardiac failure. Nowadays, the tumours are usually diagnosed by echocardiography, magnetic resonance imaging and cardiac catheterization. Surgical excision is the treatment of choice if the tumour causes either arrhythmia or cavitary obstruction. In this report, we describe a giant ventricular fibroma co-existing with an atrial septal defect in a girl aged 15 years. © 2009 Cambridge University Press.De Cobelli F, 2005, CIRCULATION, V112, pE242, DOI 10.1161-CIRCULATIONAHA.104.487231; Dulac Y, 2006, ARCH PEDIATRIE, V13, P1416, DOI 10.1016-j.arcped.2006.06.023; LIN TY, 2004, J CLIN ONCOL, V22, P1153; NATARAJAN P, 1982, CATHETER CARDIO DIAG, V8, P267, DOI 10.1002-ccd.1810080309; Ohashi T, 2006, ANN THORAC SURG, V82, P1512, DOI 10.1016-j.athoracsur.2006.01.101; Paraskevaidis IA, 2003, J THORAC CARDIOV SUR, V126, P913, DOI 10.1016-S0022-5223(03)00356-8; PARMLEY LF, 1988, ANN THORAC SURG, V45, P455; WILLIAMS DB, 1992, J THORAC CARDIOVASC, V84, P23022
The current status of HPV DNA testing
No full textInfection with high-risk types of HPV underlies most cases of high-grade cervical intraepithelial neoplasia (CIN) and practically all cases of invasive cervical cancer. Currently, cervical HPV DNA is detected by means of PCR and sandwich capture molecular hybridization methods. Research has focused on the potential role of HPV testing in three conditions: screening for cervical neoplasia, triage of women with low-grade lesions and follow-up after conservative surgical treatment for CIN. Concerning the first condition, HPV testing does not seem to offer an obvious advantage over traditional cytology screening, mainly due to false positive results in younger women with transient HPV infection. A possible exemption to this is the case of middle-aged women and low-resource settings, where the excellent sensitivity of a HPV test is desirable. Although data are controversial regarding low grade lesions, results from randomized studies indicate that HPV testing could be useful in a triage of women with an initial cytological diagnosis of ASCUS, where detection of DNA of a high-risk type should lead to colposcopy. Although there is a lack of randomized controlled trials in this field, data from observational studies indicate that HPV DNA testing after conservative surgical treatment for CIN may be very sensitive and detect early residual and recurrent disease.Eur J Gynaecol Onco
Calibration of myocardial T2 and T1 against iron concentration.
No full textBACKGROUND: The assessment of myocardial iron using T2* cardiovascular magnetic resonance (CMR) has been validated and calibrated, and is in clinical use. However, there is very limited data assessing the relaxation parameters T1 and T2 for measurement of human myocardial iron.
METHODS: Twelve hearts were examined from transfusion-dependent patients: 11 with end-stage heart failure, either following death (n=7) or cardiac transplantation (n=4), and 1 heart from a patient who died from a stroke with no cardiac iron loading. Ex-vivo R1 and R2 measurements (R1=1/T1 and R2=1/T2) at 1.5 Tesla were compared with myocardial iron concentration measured using inductively coupled plasma atomic emission spectroscopy.
RESULTS: From a single myocardial slice in formalin which was repeatedly examined, a modest decrease in T2 was observed with time, from mean (± SD) 23.7 ± 0.93 ms at baseline (13 days after death and formalin fixation) to 18.5 ± 1.41 ms at day 566 (p<0.001). Raw T2 values were therefore adjusted to correct for this fall over time. Myocardial R2 was correlated with iron concentration [Fe] (R2 0.566, p<0.001), but the correlation was stronger between LnR2 and Ln[Fe] (R2 0.790, p<0.001). The relation was [Fe] = 5081•(T2)-2.22 between T2 (ms) and myocardial iron (mg/g dry weight). Analysis of T1 proved challenging with a dichotomous distribution of T1, with very short T1 (mean 72.3 ± 25.8 ms) that was independent of iron concentration in all hearts stored in formalin for greater than 12 months. In the remaining hearts stored for <10 weeks prior to scanning, LnR1 and iron concentration were correlated but with marked scatter (R2 0.517, p<0.001). A linear relationship was present between T1 and T2 in the hearts stored for a short period (R2 0.657, p<0.001).
CONCLUSION: Myocardial T2 correlates well with myocardial iron concentration, which raises the possibility that T2 may provide additive information to T2* for patients with myocardial siderosis. However, ex-vivo T1 measurements are less reliable due to the severe chemical effects of formalin on T1 shortening, and therefore T1 calibration may only be practical from in-vivo human studies
A case of pulmonary vein obstruction: Evaluation using newer echocardiographic imaging techniques
No full textA 59-year-old woman was admitted in our hospital due to persistent cough and dyspnea. Transthoracic 2-dimensional echocardiography demonstrated a cardiac mass (29×34 mm) that extended from the right upper pulmonary vein into the left atrium causing the partial obstruction of the right lower vein as indicated by the increased Doppler velocities. Contrast echocardiography confirmed the presence of microcirculation within the mass. During transesophageal (TEE) echocardiographic study, color Doppler imaging and power Doppler imaging (Angio® Vivid 7, GE Medical System, Horten, Norway) demonstrated the presence of vascular flow within the mass. A chest magnetic resonance tomography showed a pulmonary mass of 30×25×28 mm infiltrating the pulmonary veins. After surgery, biopsy confirmed a high grade mucoepidermoid lung cancer with few large arterioles. The new echocardiographic techniques can reliably differentiate a cardiac tumor from a cardiac thrombus. © The Author 2007
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