Human Papilloma Virus infection in sexually active adolescent girls

Purpose

Adolescents are a vulnerable group with regard to sexually transmitted infections, including Human Papilloma Virus (HPV). This is thought to be both because of their more liberal sexual behavior and also the relative immaturity of their genital tract.The aim of the study was to examine trends in HPV infection among sexually active adolescents attending for a sexual health screen.

Methods

Sexually active adolescents were offered cervical screening, HPV typing and conventional genital cultures as part of a sexual health prevention protocol. Participating adolescents also completed a sexual health questionnaire.

Results

Between January 2008 and July 2011, 149 sexually active girls were examined for reproductive health issues (mean age 17.3 years). 62 (42%) tested positive for HPV DNA, 30 were infected by multiple types and 54 had at least one high risk type identified. The most commonly identified HPV DNA was for low risk type 42 (15 cases, 7.8%), followed by high risk types 51 (14 cases, 7.3%) and 59 (11 cases, 5.7%). E6-E7 mRNA expression was detected in 16 girls (11%), of which half were for HPV 16. Girls who tested positive for HPV DNA and mRNA had similar age at sexual debut with those that tested negative (15.1 years in all groups) but had on average more sexual partners (4.1 vs1.9 p = 0.007).Only 9 girls in this cohort had been vaccinated against HPV. Approximately half of the girls reported using inadequate or no contraception.

Conclusions

HPV infection rate was high in our sample. Furthermore a high percentage was infected with high risk types and a proportion of girls demonstrated mRNA HPV expression. As age at first sexual intercourse drops, vaccination against HPV and sexual education should be instituted in early adolescence, in order to reduce long term reproductive sequelae of unsafe sexual practices.     

Multiple idiopathic cervical root resorption: Case report of an unusual presentation

Idiopathic cervical root resorption (ICRR) is a rare condition involving the cemento‐enamel junction of the teeth. Multiple idiopathic cervical root resorption (MICRR) involves several teeth with an unknown prevalence and aetiology. The resorptive lesions are often detected on routine radiographs or during clinical examination. The defects are often painless, hence they are usually diagnosed late and in an advanced stage when diagnosed clinically. The restoration of MICRR can be demanding with subsequent loss of the teeth affected. In this report, we describe the case of a 16‐year‐old female with MICRR, the therapeutic challenges and clinical burden for this young patient over a period of approximately 5 years.     

Metastatic lung angiosarcoma from a femoral subperiosteal origin

Primary malignant vascular bone tumors are unusual and include hemangioendothelioma, epitheloid hemangioendothelioma and angiosarcoma. Although few cases of primary bone angiosarcomas have been reported, those of femoral origin are even more infrequent. Such tumors diagnosis may be challenging due to their radiographic and histologic variety. We present a case of a 24-yearold woman with a subperiosteal diaphyseal angiosarcoma originating from the femoral bone and metastatic to the lung at the time of diagnosis. The clinical, histological and radiological features of this extremely rare lesion are presented.     

Reforming the reform: the Greek National Health System in transition

The National Health System (ESY) in Greece, which was established in 1983, is in a state of continuous crisis. This situation is caused mainly by the system's problematic administration, low productivity and inadequate Primary Health Care. These have led the re-elected PASOK government to introduce by the end of 2000 a radical reform of the health system. The 200 reform measures announced by the new Minister of Health and Welfare include changes aiming at: the decentralization of the ESY, the creation of a unified financing system for the social insurance funds, a new management structure in public hospitals, the organization of a Primary Health System in urban areas, and the strengthening of Public Health and Health Promotion. These changes are presented and discussed in this paper.     

Left dominant arrhythmogenic cardiomyopathy: A morbid association of ventricular arrhythmias and unexplained infero-lateral T-wave inversion

Left-dominant arrhythmogenic cardiomyopathy is a subtype of arrhythmogenic right ventricular cardiomyopathy characterized by early predominant left ventricular involvement. Α 34-year-old man presented with palpitations and a history of frequent ventricular extrasystoles of both LBBB and RBBB configuration. Cardiac workup revealed repolarization abnormalities at infero-lateral leads in the absence of diagnostic structural/functional alterations or obstructive coronary artery disease. Six months later he died suddenly. Histopathology was diagnostic for arrhythmogenic right ventricular cardiomyopathy affecting predominantly the left ventricle at subepicardial/midwall myocardial layers. Thus, ventricular arrhythmias accompanied by unexplained infero-lateral T-wave inversion should warn of a possible morbid association underlying left-dominant arrhythmogenic cardiomyopathy.