EUROGIN 2011 roadmap on prevention and treatment of HPV-related disease

The EUROGIN 2011 roadmap reviews the current burden of human papillomavirus (HPV)-related morbidity, as well as the evidence and potential practice recommendations regarding primary and secondary prevention and treatment of cancers and other disease associated with HPV infection. HPV infection causes ～600,000 cases of cancer of the cervix, vulva, vagina, anus and oropharynx annually, as well as benign diseases such as genital warts and recurrent respiratory papillomatosis. Whereas the incidence of cervical cancer has been decreasing over recent decades, the incidence of anal and oropharyngeal carcinoma, for which there are no effective screening programs, has been rising over the last couple of decades. Randomized trials have demonstrated improved efficacy of HPV-based compared to cytology-based cervical cancer screening. Defining the best algorithms to triage HPV-positive women, age ranges and screening intervals are priorities for pooled analyses and further research, whereas feasibility questions can be addressed through screening programs. HPV vaccination will reduce the burden of cervical precancer and probably also of invasive cervical and other HPV-related disease in women. Recent trials demonstrated that prophylactic vaccination also protects against anogenital HPV infection, anogenital intraepithelial lesions and warts associated with vaccine types, in males; and anal HPV infection and anal intraepithelial neoplasia in MSM. HPV-related oropharyngeal cancer could be treated less aggressively because of better survival compared to cancers of the oropharynx unrelated to HPV. Key findings in the field of cervical cancer prevention should now be translated in cost-effective strategies, following an organized approach integrating primary and secondary prevention, according to scientific evidence but adapted to the local situation with particular attention to regions with the highest burden of disease.     

Sinovenous thrombosis associated with skull fracture in the setting of blunt head trauma

Background

Emerging literature suggests that closed head injuries may be an important etiology of cerebral venous sinus thrombosis (CVST). Fractures over the dural sinuses, in particular, may predispose such patients to this secondary complication. The purpose of this study was to determine the incidence and characteristics of CVST resulting from skull fractures overlying cerebral venous sinuses at a single tertiary care center.

Methods

A retrospective review of consecutive patients presenting to our institution with skull fractures from blunt head trauma between 1 January 2009 and 31 December 2011 who underwent either a computed tomography (CT) or magnetic resonance (MR) venogram. Patient demographics, associated intracranial injuries, admission Glasgow Coma Scale (GCS), presence of CVST, and post-hospital disposition were recorded.

Results

Overall, 908 patients with skull fractures presented to the institution. Of those, 63 had fractures over a sinus and a venogram satisfying inclusion criteria. Twenty-two (34.9 %) patients demonstrated a thrombus in at least one sinus. There was no statistical difference in patient demographics, presenting GCS, length of stay (LOS), or outcome between patients with or without a thrombus. Pediatric patients had significantly shorter LOS (11 vs. 4 days, p?<?0.01) compared to adults. Adults had a greater incidence of total sinus occlusions while children had more non-occlusive thrombus formations; both were statistically significant (p?=?0.035 and p?=?0.037, respectively).

Conclusions

This report suggests that over 10 % of skull fractures involve cerebral venous sinuses, thus emphasizing the need to rule out CVST in patients suffering blunt head trauma. We propose including a venogram as part of the initial trauma work-up for these patients. Moreover, our data suggest that pediatric patients may be predisposed to less severe injuries than their adult counterparts.     

Use of Nucleoside (Tide) Analogues in Patients with Hepatitis B-Related Acute Liver Failure

Background and Aims  

The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF.     

Successful management of cutaneous mucormycosis by delaying debridement

Mucormycosis is a frightening medical condition which has baffled clinicians all over the world. Cutaneous mucormycosis is, in particular, extremely invasive, leading to high rates of morbidity and mortality. Timely intervention with antifungal drug Amphotericin B and early radical debridement are keys for favorable outcome.Three consecutive patients died of cutaneous mucormycosis despite being treated with Amphotericin B and an early extensive debridement. With disappointing results in these patients, the treatment protocol was changed. Instead of early aggressive surgical intervention, the debridement was withheld for minimum 10 days or more, until Amphotericin B started to show its effect. Debridement was carried out conservatively after 10 days. The resultant raw area was covered with the split-thickness skin graft later.The concept of "Delay the Debridement" was efficacious in the successive 5 patients with minimum morbidity and less reconstructive requirements. Our study contradicts the popular wisdom of the necessity of early vigorous debridement. We think that the timing of debridement is one of the most important determinants of mortality.The scientific reasons for delaying the debridement have been discussed. This appears to be the first report of successful management of cutaneous mucormycosis by delaying the debridement.     

Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women

Objective

To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States.

Methods

A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception.

Results

A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (< 0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5).

Conclusion

Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed.     

Premorbid echocardiography and risk of hospitalization in COVID-19

The International Journal of Cardiovascular Imaging - COVID-19 has caused a global pandemic unprecedented in a century. Though primarily a respiratory illness, cardiovascular risk factors predict...     

Prostate-specific antigen, sexual behavior, and sexually transmitted infections in US men 40–59 years old, 2001–2004: a cross – sectional study

This is a short summary of a meeting of the "African-Caribbean Cancer Consortium", jointly organized by the University of Pittsburgh, Department of Epidemiology and the University of Pittsburgh Cancer Institute, held in Montego Bay, Jamaica as a satellite meeting at the Caribbean Health Research Council, 52^nd Annual Council and Scientific meeting on May 4, 2007.