Transvaginal sonography in the diagnosis of acute appendicitis.

OBJECTIVES: To evaluate transvaginal sonography with power Doppler capacity in the diagnosis of acute appendicitis and in discriminating appendicitis from pelvic inflammatory disease. PATIENTS AND METHODS: We describe transvaginal sonographic findings of six women with acute appendicitis selected from 31 women seen in an emergency room setting for clinically suspected pelvic inflammatory disease. The study population underwent gray-scale transvaginal sonography, and specific sonographic landmark findings for acute appendicitis and pelvic inflammatory disease were used. Hyperemia of any infectious complex was identified by power Doppler. Laparoscopy was performed after transvaginal sonography and was used as the gold standard. RESULTS: Laparoscopy showed acute appendicitis in six (19%) of the 31 patients. A thick walled non-compressible gas-containing tubular structure with a diameter exceeding 6 mm was seen by transvaginal sonography in four of the six cases, consistent with uncomplicated appendicitis. A heterogeneous complex with surrounding hyperechogenic soft tissue was seen in two cases with gangrenous appendicitis. Power Doppler detected hyperemia in all six cases. Normal adnexal structures were imaged next to the inflamed appendix. The sonographic criteria consistent with acute appendicitis were clearly different from those of acute pelvic inflammatory disease. CONCLUSIONS: Transvaginal sonography provides an opportunity to distinguish between appendicitis and acute pelvic inflammatory disease. Prospective trials are needed in order to evaluate the impact of transvaginal sonography in the diagnosis of acute appendicitis.     

Chronic rejection of rat aortic allografts: effect of inhibition of the thromboxane cascade

Non-immunosuppressed rat aortic allografts from DA (RT1^av1) to WF (RT1^u) strain develop, after a short reversible acute rejection episode, chronic arteriosclerotic changes in the vascular wall, which are indistinguishable from those seen in human allografts during chronic rejection [1]. Incubation of the aortic wall segments in vitro and immunochemical assays demonstrated that the allografts synthesized increased amounts of TxB2, but not 6-keto-PGF_1α or LTB4, compared to syngenic or normal aortas. The two major cellular components of the vascular wall, intima and adventitia, were incubated separately after microdissection. TxB2 was produced in the adventitia, whereas most of the 6-keto-PGF₁α was synthesized in the intima. Administration of a specific TxA2 receptor inhibitor to the recipient rat reduced significantly the proliferation of adventitial inflammatory cells and the intimal smooth muscle cells. Nevertheless, it only delayed but did not inhibit the overall sclerosis of the intima.     

Four-year follow-up study of sleep and psychiatric symptoms in preadolescents: relationship of persistent and temporary sleep problems to psychiatric symptoms

The course of sleep disturbances in preadolescents was assessed during a 4-year follow-up, and psychiatric problems associated with persistent and temporary sleep problems were investigated in an epidemiological setting. A representative random sample of 1,290 children, their parents, and school teachers filled out various questionnaires when the children were aged 8 and 12 years. Response rates to the relevant items varied between 66.8% and 81.2%. Parental reports of sleep problems decreased from 23.4% to 9.1% during the 4-year period, whereas children's reports remained steady at 18%. Persistent sleep disturbances were found in 12% of children, and 33.3% of sleep problems reported at age 8 were continued. Both current and persistent sleep disturbances were associated with the broad range of mental health problems reported by teachers. However, multivariate modeling suggested that especially current sleep problems were associated with an increased risk for psychiatric problems (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.20-4.99), particularly emotional problems (OR 2.92; 95% CI 1.58-5.38).     

International variation in histologic grading is large,and persistent feedback does not improve reproducibility

Histologic grading systems are used to guide diagnosis, therapy, and audit on an international basis. The reproducibility of grading systems is usually tested within small groups of pathologists who have previously worked or trained together. This may underestimate the international variation of scoring systems. We therefore evaluated the reproducibility of an established system, the Banff classification of renal allograft pathology, throughout Europe. We also sought to improve reproducibility by providing individual feedback after each of 14 small groups of cases. Kappa values for all features studied were lower than any previously published, confirming that international variation is greater than interobserver variation as previously assessed. A prolonged attempt to improve reproducibility, using numeric or graphical feedback, failed to produce any detectable improvement. We then asked participants to grade selected photographs, to eliminate variation induced by pathologists viewing different areas of the slide. This produced improved kappa values only for some features. Improvement was influenced by the nature of the grade definitions. Definitions based on "area affected" by a process were not improved. The results indicate the danger of basing decisions on grading systems that may be applied very differently in different institutions.     

Chlamydia trachomatis in acute salpingitis

Of the 228 hospitalized patients who had acute salpingitis, 69 (30%) harbored Chlamydia trachomatis in the lower genital tract (LGT). The mean antichlamydial lgG immunofluorescence antibody titer was 264 in sera from the C. trachomatis culture-positive patients but only 49 in. culture-negative patients. In paired sera obtained from 167 of the patients, 32% of the culture-positive patients and 13% of the culture-negative patients showed significant titer change. Patients with abscess formation had higher mean antichlamydial antibody titer than the group with no abscess (192 vs. 53), although there was no difference between the groups in positive chlamydial cultures from the LGT (33% vs. 29%). Overall, this study indicates that C. trachomatis is a common etiologic agent in acute salpingitis, emphasizing the need to treat chlamydial cervicitis before this complication develops.     

L-selectin ligands in rat high endothelium: multivalent sialyl Lewis x glycans are high-affinity inhibitors of lymphocyte adhesion

Lymphocyte homing is initiated by their tethering to and rolling on the high endothelium and is followed by extravasation into the lymph nodes. We show here that glycosylated cell adhesion molecule-1 (GlyCAM-1), CD34, and sialyl Lewis x (sLex) are present on rat lymph node high endothelium analyzed by using monoclonal antibodies. α(1,3)fucosyltransferase VII (Fuc-TVII), the last enzyme involved in the synthesis of the sLex sequence is also expressed on the rat lymph node high endothelium. We have synthesized a family of sLex-decorated oligosaccharide structures and used them to inhibit lymphocyte binding to high endothelium in the Stamper-Woodruff assay. Monovalent sLex, branched di- and tetravalent sLex, as well as a linear tetravalent sLex significantly reduce lymphocyte binding to endothelium. The branched and linear forms of tetravalent sLex were clearly superior inhibitors of the L-selectin-dependent lymphocyte adhesion, with IC50 values in low nanomolar range. In contrast, the fucose-free analogs having the same charge and approximately the same size as the corresponding sLex glycans had no effect on lymphocyte binding and served as negative controls. Taken together, these data show the crucial importance of sLex in the endothelial ligands for L-selectin. Furthermore, we suggest that L-selectin acts as an oligomer on the lymphocyte surface as it binds multivalent sLex glycans.     

A discrepancy of <Emphasis Type="Italic">Chlamydia trachomatis</Emphasis> incidence and prevalence trends in Finland 1983–2003

Background  

Reported rates of Chlamydia trachomatis are on the rise contradicting the declining rates of C. trachomatis associated reproductive sequelae in Western countries. Population based evaluation of the real trend of C. trachomatis infection is important to contemplate prevention efforts. We studied C. trachomatis occurrence during the past 20 years in Finland comparing incidence rate data based on serology and reported C. trachomatis laboratory notifications.     

The impact of a quadrivalent human papillomavirus (types 6, 11, 16, 18) virus-like particle vaccine in European women aged 16 to 24

Background  Quadrivalent human papillomavirus (HPV types 6/11/16/18) L1 VLP vaccine is highly effective in preventing HPV 6/11/16/18-related cervical and external genital disease. Herein, we evaluated the impact of the quadrivalent HPV 6/11/16/18 L1 VLP vaccine on prevention of HPV-associated cervico-genital lesions in a broad population of sexually active European women.
Methods  Female subjects ( N = 9265) aged 16–24 with four or fewer lifetime sexual partners were enrolled and randomized to quadrivalent HPV vaccine or placebo. Subjects underwent cervicovaginal sampling for HPV DNA detection. Papanicolaou testing and anti-HPV 6/11/16/18 serology testing was also performed.
Results  Vaccine efficacy against lesions representing immediate cervical cancer precursors (cervical intraepithelial neoplasia grade 2/3 or adenocarcinoma in situ ) related to HPV 6/11/16/18 in the per-protocol population was 100.0%[95% confidence interval (95% CI), 89.8–100.0]. Efficacy against external genital lesions (vulvar or vaginal intraepithelial neoplasia, condyloma, vulvar or vaginal cancer) related to vaccine HPV types in the per-protocol European population was 99.0% (95% CI, 94.4–100.0).
Conclusion  These data demonstrate that quadrivalent HPV 6/11/16/18 vaccination programs in 16- to 24-year-old European women can be beneficial.
NCT0009252, NCT00092534, NCT00092495     

Repeated human papillomavirus DNA findings among female university students

In a previous study, we found a high (33%) human papillomavirus (HPV) DNA prevalence among first year university students in the Helsinki metropolitan area. We have now performed HPV rescreening among first-round HPV-positive students using a liquid-based hybridization assay. A total of 212 students participated in rescreening, and 82 (38.7%) of 212 were found to be positive for HPV DNA. Low-risk (lr) HPV DNA was repeatedly found in 16.8% of the patients who had been lr positive in the first screening round. High-risk (hr) HPV DNA was repeatedly found in 33.3% of the patients. Although HPV typing in these samples has not been carried out yet, we conclude that repeatedly positive HPV DNA findings were strikingly common. hrHPV DNA was repeatedly found twice as often as lrHPV DNA. HPV DNA prevalence was higher among oral contraceptive users than among patients using other contraception.