Persistent infection with human papillomavirus following the successful treatment of high grade cervical intraepithelial neoplasia.

In a need case-control study, we identified women who were successfully treated for CIN 3. Cases had biopsy proven recurrence, whilst controls remained disease free for at least five years. One hundred and seventy-two women were beta-globin positive at diagnostic and at six-month post-treatment smear (90 controls and 82 cases).

Enoxaparin in acute coronary syndromes: evidence for superiority over placebo or untreated control.

Background: Heparins, both standard unfractionated heparin (SUFH) and low-molecular weight heparin, play a prominent role in the treatment of acute coronary syndromes. Enoxaparin has been shown in 2 trials to be superior to heparin but has not been compared with placebo or untreated control.

Methods: A putative enoxaparin versus placebo/control odds ratio (OR) was computed with a recently described statistical technique with the logarithm of the ORs of the pooled results of both the enoxaparin-SUFH trials and SUFH-placebo or controlled trials.

The number remaining at risk: an adjunct to the number needed to treat.

Although the number of patients needed to treat (NNT) to prevent an adverse clinical event is of great clinical value to practising physicians, it is limited in that it fails to provide a measure of prognosis among patients not achieving benefit. For example, if the NNT is 100, what is likely to happen to the other 99? The number remaining at risk (NRR), which is an index that enhances the value of the NNT, is described. The NRR is the ratio of the residual event rate among treated patients and the absolute reduction in outcome events (NRR = experimental event rate [EER]/control event rate [CER]-EER), where EER and CER are the event rates among experimental and control groups, respectively.

Human papillomavirus as a form of risk assessment.

There is a huge amount of interest in the use of human papillomavirus testing to improve both the sensitivity and specificity of cervical screening. Although oncogenic human papillomavirus subtypes are recognized to be the most important factor in the development of cervical disease, only a minority of such infections results in invasive cancer. Given our current, albeit limited, knowledge of the natural history of human papillomavirus infection and the development of cervical intra-epithelial neoplasia, it may be possible to identify well-defined high-risk groups of women.

Cytochrome P450 CYP1B1 over-expression in primary and metastatic ovarian cancer.

Ovarian cancer is the most frequent cause of death from gynaecological malignancies world wide. Little improvement has been made in the long-term outcome of this disease, with the 5-year survival of patients only 30%. This poor prognosis is due to the late presentation of the disease and to the unpredictable response of ovarian cancer to chemotherapy.

Dalteparin as periprocedure anticoagulation for patients on warfarin and at high risk of thrombosis.

Background: Patients taking warfarin and at high risk for thromboembolic complications have traditionally been hospitalized for two to three days to receive standard treatment with intravenous heparin both prior to and following procedures while their international normalized ratio (INR) is subtherapeutic.

Objective: To assess the feasibility of protocol implementation for outpatient anticoagulation with low-molecular-weight heparin to eliminate or reduce the length of hospital admission needed solely for anticoagulation.

Methods: Patients included were receiving warfarin for a prosthetic heart valve, mitral valve disease with atrial fibrillation, or recent episode of venous thromboembolism.

Use of interventions for reducing mother-to-child transmission of HIV in Australia.

Objective: To describe the extent and outcome of use of interventions for reducing the risk of HIV transmission from mother to child in Australia.

Design: National surveillance for perinatal exposure to HIV.

Participants And Setting: Notified cases of HIV infection in women in Australia and their perinatally exposed children, 1982-1999.

Docetaxel-carboplatin as first line chemotherapy for epithelial ovarian cancer.

A prospective, non-randomized, multicentre, open, dose-finding study of a carboplatin-docetaxel (C-D) combination as first-line chemotherapy in FIGO stage Ic-IV epithelial ovarian cancer. C-D was given 3-weekly for 6 planned cycles, with a 3-day prophylactic dexamethasone regimen (8 mg b.i.

Greater expectations in a cancer trial: absolute more than relative survival increases, community more than academic clinicians.

There is no consensus on how the difference between control and experimental outcome rates, the clinically important difference, should be estimated when designing a clinical trial. We sought to determine whether community and academic clinicians had different perceptions as to what would constitute a clinically important increase in survival, when asked to respond in absolute or relative terms, before a trial was started rather than when the results were already known. A telephone survey of 25 practicing Canadian oncologists was performed.

Relationship between nutritionally-mediated placental growth restriction and fetal growth, body composition and endocrine status during late gestation in adolescent sheep.

The aim was to investigate the consequences of nutritionally-mediated placental growth restriction on fetal organ growth, conformation, body composition and endocrine status during late gestation. Embryos recovered from superovulated adult ewes inseminated by a single sire were transferred in singleton to the uterus of peripubertal adolescent recipients. Post-transfer, adolescent dams were offered a high (H) or moderate (M) level of a complete diet to promote rapid or moderate maternal growth rates, respectively (n=7 per group).

Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity.

Upper extremity deep vein thrombosis (DVT) is now recognized as a major cause of morbidity and mortality. There is little information regarding the most effective treatment of this condition. We report a prospective cohort study of the use of low molecular weight heparin (LMWH) in the outpatient management of upper extremity DVT.

Human papillomavirus type 16 and 18 detection in the management of mild dyskaryosis.

Objective: To determine if semi-quantitative human papillomavirus (HPV) types 16 and 18 detection by polymerase chain reaction can increase the sensitivity and specificity of repeat cytology alone for underlying high grade cervical intraepithelial neoplasia (CIN).

Design: Prospective randomised study of immediate treatment and surveillance.

Setting: A dedicated colposcopy clinic serving a regional population.

Switching maternal dietary intake at the end of the first trimester has profound effects on placental development and fetal growth in adolescent ewes carrying singleton fetuses.

The aim was to investigate whether placental growth and hence pregnancy outcome could be altered by switching adolescent dams from a high to a moderate nutrient intake, and vice-versa, at the end of the first trimester. Embryos recovered from adult ewes inseminated by a single sire were transferred in singleton to peripubertal adolescents. After transfer, adolescent ewes were offered a high (H, n = 33) or moderate (M, n = 32) level of a diet calculated to promote rapid or moderate maternal growth rates, respectively.

Idiopathic thrombocytopenia after cytomegalovirus infection in a renal transplant recipient.

Infection with cytomegalovirus (CMV) is a frequent complication of organ transplantation and presents a spectrum of disease ranging from asymptomatic viremia to life-threatening tissue-invasive disease. CMV is also lymphotrophic, with the potential to induce autoimmune disease, although immunosuppressive therapy may prevent or attenuate the clinical course in transplant patients. We report a case of idiopathic thrombocytopenic purpura occurring in a renal transplant recipient after primary CMV infection and discuss the possible mechanisms involved.

Randomized assessment of a warfarin nomogram for initial oral anticoagulation after venous thromboembolic disease.

Standard treatment for venous thromboembolism is parenteral heparin followed by warfarin. In this study we assess whether a standardized method of ordering warfarin reduces the duration of hospitalization. Consecutive patients were randomized to receive warfarin managed by attending physicians or by a nomogram.

Body weight does not predict for anti-Xa levels after fixed dose prophylaxis with enoxaparin after orthopedic surgery.

Enoxaparin after joint arthroplasty is effective prophylaxis against venous thromboembolism. This is usually given as a fixed dose without monitoring of anti-Xa levels. This study assesses the relationship between trough anti-Xa levels, body weight, and venous thromboembolism.

Maternal endocrine status in relation to pregnancy outcome in rapidly growing adolescent sheep.

It has previously been reported that high nutrient intakes which promote rapid maternal growth throughout pregnancy are associated with poor pregnancy outcome when compared with normally growing adolescent animals. The present study examined the maternal plasma concentrations of a number of putative endocrine regulators of nutrient partitioning between the maternal and fetal compartments in relation to placental and fetal growth in this novel experimental paradigm. Embryos were recovered on day 4 after oestrus from superovulated adult ewes that had been inseminated using semen from a single sire and synchronously transferred, in singleton, to the uterus of peripubertal adolescent recipients (n = 38), which had been induced to ovulate at 32 weeks of age (live weight 47.

The case for stopping cervical screening at age 50.

Objective: To determine the pattern of abnormal cervical cytology in women aged 50 to 60 years and to determine whether the development of cervical neoplasia in this age group is confined to women who have been inadequately screened.

Design: Retrospective case analysis study.

Population: An 11-year birth cohort of women in Grampian Region born between 2/10/33 and 1/10/44, and those who had significant cytological abnormalities in the 5 year period 1/10/89 to 30/9/94.

Perinatal exposure to HIV in Australia, 1982-1994.

Objective: To describe the pattern of perinatal exposure to HIV in Australia from 1 January 1982 to 31 December 1994.

Design: National surveillance for perinatal exposure to HIV.

Participants And Setting: Women with diagnosed HIV infection in Australia whose children were exposed to HIV perinatally.

Prevention of venous thromboembolism after knee arthroplasty. A randomized, double-blind trial comparing enoxaparin with warfarin.

Objective: To compare the effectiveness and safety of fixed-dose enoxaparin and adjusted dose warfarin in preventing venous thromboembolism after knee arthroplasty.

Design: A randomized, double-blind controlled trial.

Setting: 8 university hospitals.

Colposcopy services provided by Genito-Urinary Medicine clinics in the United Kingdom--British Society for Colposcopy and Cervical Pathology/National Co-ordinating Network Survey, 1993.

Postal questionnaires were circulated to all Genito-Urinary Medicine (GUM) clinics in the UK (in parallel with questionnaires circulated to gynaecologists) on behalf of British Society for Colposcopy and Cervical Pathology (BSCCP) and National Co-ordinating Network (NCN) to audit colposcopy services. Information was sought on colposcopy workload, referral criteria, treatment method and followup, waiting times, staffing and training. A similar but less comprehensive survey of colposcopy services in GUM was undertaken in 1990 enabling direct comparison of some but not all aspects of the service in the last 3 to 4 years.

The 1993 British Society for Colposcopy and Cervical Pathology/National Coordinating Network United Kingdom Colposcopy Survey. Comparison with 1988 and the response to introduction of guidelines.

Objective: To evaluate colposcopic practice over a 12-month period in the UK, April 1993 to March 1994, to compare this with 1988, and to test penetration and acceptance of previously introduced national guidelines.

Design: A nationwide survey of colposcopy practice by postal questionnaire, including referral criteria, diagnosis and treatment, follow up, waiting times and information and counselling.

Setting: All gynaecology clinics in the United Kingdom.

Fertility and pregnancy outcome following large loop excision of the cervical transformation zone.

Objective: To determine if large loop excision of the transformation zone affects subsequent fertility and pregnancy outcome.

Design: A case-control study.

Setting: A teaching hospital serving a regional population.