How many sexually transmitted infections (STIs) will we miss?--an algorithm to assess risk factors for STI.

A self-administered algorithm for the assessment of symptoms of, and risk factors for, sexually transmitted infection (STI) was developed. The algorithm was applied retrospectively to all cases of STI other than chlamydia diagnosed over a one-year period, to estimate the risk of missing STI diagnoses by its introduction. Three hundred and eighty-nine cases were identified, of whom 81 (21%) were asymptomatic.

The tip of the iceberg: a giant pelvic atypical lipoma presenting as a sciatic hernia.

Background: This case report highlights two unusual surgical phenomena: lipoma-like well-differentiated liposarcomas and sciatic hernias. It illustrates the need to be aware that hernias may not always simply contain intra-abdominal viscera.

Case Presentation: A 36 year old woman presented with an expanding, yet reducible, right gluteal mass, indicative of a sciatic hernia.

Review of 212 individuals attending a city centre genitourinary medicine clinic following acute sexual assault.

A retrospective case note review of 212 individuals (190 women) attending a city-centre Genitourinary Medicine clinic between 1/4/2002 and 31/3/2004 following an acute sexual assault. Direct referral by the Forensic Medical Examiner to the dedicated weekly clinic for victims of sexual assault facilitated the attendance of 55/113 attending the dedicated clinic. The 99 individuals who did not disclose a recent assault as the reason for attendance were seen at routine clinics.

The significance of voiding interval before testing urine samples for Chlamydia trachomatis in men.

Objective: To investigate the effect of time since last urination on chlamydial positivity rates in men.

Methods: Prospective study on men attending a genitourinary medicine clinic who were asked for the last time of their urination before obtaining their urine sample for testing for Chlamydia trachomatis with the Cobas Amplicor polymerase chain reaction (PCR) assay.

Results: Of the total of 1649 men studied, 621 (37.

Surgery for degenerative lumbar spondylosis.

Background: Surgical investigations and interventions account for large health care utilisation and costs, but the scientific evidence for most procedures is still limited.

Objectives: Degenerative conditions affecting the lumbar spine are variously described as lumbar spondylosis or degenerative disc disease (which we regarded as one entity) and may be associated with back pain and associated leg symptoms, instability, spinal stenosis and/or degenerative spondylolisthesis. The objective of this review was to assess current scientific evidence on the effectiveness of surgical interventions for degenerative lumbar spondylosis.

Audit of treatment and contact-tracing rates in immediate (presumptive) versus delayed (polymerase chain reaction) diagnosis of chlamydial infection.

An audit of all cases of chlamydial infection diagnosed in men at the Edinburgh genitourinary (GU) medicine clinic over a six-month period from January 2003 is reported. In all, 189 men identified as requiring treatment for possible chlamydial infection on first attendance (because of contact with a partner with chlamydia or the diagnosis of non-gonococcal urethritis [NGU] on microscopy), who later proved chlamydia-positive by polymerase chain reaction (PCR), were compared with 83 men in whom infection was identified only on receipt of a PCR result. Treatment rates were 100% in the first group and 97.

Concurrent gonococcal and chlamydial infections among men attending a sexually transmitted diseases clinic.

The aim of this retrospective study was to determine the prevalence of Chlamydia trachomatis co-infection in men with gonorrhoea attending a sexually transmitted diseases clinic in Edinburgh, Scotland. During the study period, there were 660 cases of culture-proven gonorrhoea. Chlamydial DNA was detected in the urethra in 79 (31%; 95% confidence interval [CI], 25-37%) heterosexual men who have sex with women (MSW); the median age was significantly lower than those with gonorrhoea alone (24.

Pharmacological cardioversion for atrial fibrillation and flutter.

Background: Atrial fibrillation is the commonest cardiac dysrhythmia. It is associated with significant morbidity and mortality. There are two approaches to the management of atrial fibrillation: controlling the ventricular rate or converting to sinus rhythm in the expectation that this would abolish its adverse effects.

Surgery for degenerative lumbar spondylosis.

Background: Surgical investigations and interventions account for large health care utilisation and costs, but the scientific evidence for most procedures is still limited.

Objectives: Degenerative conditions affecting the lumbar spine are variously described as lumbar spondylosis or degenerative disc disease (which we regarded as one entity) and may be associated with back pain and associated leg symptoms, instability, spinal stenosis and/or degenerative spondylolisthesis. The objective of this review was to assess current scientific evidence on the effectiveness of surgical interventions for degenerative lumbar spondylosis.

Can we identify women at risk of more than one termination of pregnancy?

One in five women will have more than one abortion in her lifetime. This study was designed to identify risk factors in women requesting termination of pregnancy (TOP) after previous TOPs so that women at risk of recurrence, attending for the first time, could be identified. A retrospective case note review of 358 women undergoing TOP during October and November 2000 was performed.

Heterosexual men and women with HIV test positive at a later stage of infection than homo- or bisexual men.

The current strategy of offering HIV testing to individuals with known risk has had no impact on the reduction in the number of patients diagnosed with immune suppression of infection. A prospective observational study to compare the baseline CD4+ T-cell counts in HIV-infected homosexual/bisexual men, intravenous drug users, heterosexual men and women diagnosed in GUM/RIDU and that of patients diagnosed during routine maternal screening for HIV between December 1999 and January 2003 was carried out at the Departments of Genitourinary Medicine (GUM), Regional Infectious Disease Unit (RIDU) and Obstetrics in Edinburgh. Late presentation was defined as positive HIV test with baseline CD4+ T-cell count of less than 200 cells/mL.

Contact dermatitis: diagnosis and management.

Contact dermatitis accounts for 85-90% of all occupational skin diseases and, as a frequent cause of hand dermatitis, it can lead to unemployment and permanent disability. This article examines the two main types of contact dermatitis, their diagnosis and treatment.

A significant proportion of HIV-infected patients admitted to hospital have immunosuppression as a result of failure of highly active antiretroviral therapy.

Objectives: To investigate the immunological and virological features of patients on highly active antiretroviral therapy (HAART) admitted to a tertiary centre.

Methods: A retrospective study was carried out on HIV-infected patients on HAART admitted to the Regional Infectious Disease Unit in Edinburgh between June 2002 and July 2003.

Results: A total of 125 patients who had been on HAART for at least 6 months were admitted during the study period.

Safety and efficacy of a dexamethasone anterior segment drug delivery system in patients after phacoemulsification.

Purpose: To compare the safety and efficacy of the Surodex dexamethasone anterior segment drug delivery system (Oculex Pharmaceuticals, Inc.) and dexamethasone 0.1% eyedrops (Maxidex) in patients with inflammation after cataract surgery.

Classification of arterial plaque by spectral analysis in remodelled human atherosclerotic coronary arteries.

We aimed to characterise and to identify the predominant plaque type in vivo using unprocessed radiofrequency (RF) intravascular ultrasound (US) backscatter, in remodelled segments of human atherosclerotic coronary arteries. A total of 16 remodelled segments were identified using a 30-MHz intravascular ultrasound (IVUS) scanner in vivo. Of these, 9 segments were classified as positively remodelled (>1.

Evaluation of ligase chain reaction for the non-cultural detection of rectal and pharyngeal gonorrhoea in men who have sex with men.

Objectives: To compare a nucleic acid amplification test (ligase chain reaction) with culture for detecting rectal and pharyngeal gonorrhoea in men who have sex with men (MSM).

Methods: Duplicate rectal and throat swabs from MSM attending a genitourinary medicine clinic were collected for culture on modified New York City medium and detection of gonococcal nucleic acid by the Abbott ligase chain reaction (LCR) utilising probes based on opa 1 gene sequences. LCR positive culture negative specimens were tested by a second LCR utilising probes based on pilin gene sequences.

Questionnaire for teachers changes the outcome of school entrance medical examinations.

Objective: To evaluate the impact of a teachers' questionnaire on the outcome of school entrance medical examinations (SEMs).

Methodology: Retrospective audit. Routine SEMs in 17 primary schools before and after the introduction of the questionnaire.

Lung cancer: the importance of seeing a respiratory physician.

Patients with lung cancer present to and are managed by a variety of clinicians. In this study the effect of involvement by a respiratory physician on the diagnosis, staging, treatment and survival of a large unselected group of lung cancer patients was investigated. The study population was derived from the Scottish Cancer Registry.

Nesbit procedure for disabling Peyronie's curvature: a median follow-up of 84 months.

Objectives: To assess patient satisfaction with cosmetic and functional results after surgical correction for symptomatic penile curvature with the Nesbit procedure using postal questionnaire follow-up.

Methods: From 1991, 57 patients underwent surgery for a penile bend of greater than 30 degrees that was interfering with sexual function. Fifteen patients had mild to moderate erectile dysfunction on the preoperative assessment.

Peripheral intravenous cannulation and patient consent.

As nurses enhance their skills by taking on more tasks previously carried out by doctors, the need arises to be aware of consent. All nurses must have the capacity to ensure safe professional practice; consent is only one aspect of the enhanced role. The author reviews this issue through an exploration of peripheral intravenous cannulation.

Development of an automated extraction procedure for detection of human papillomavirus DNA in liquid based cytology samples.

Liquid based cytology samples are being used increasingly to improve cervical screening and have the advantage that residual cell suspension is available for other tests such as human papillomavirus (HPV) detection. However, as the transport medium is optimised for downstream cytology, problems can be experienced during extraction of nucleic acid. This study aimed to develop a robust protocol for automated extraction of HPV DNA from cervical, liquid based cytology samples using a high throughput robotic system.