Effectiveness and safety of loop electrosurgical excision procedure in a low-resource setting

Objective

To evaluate the effectiveness and safety of the loop electrosurgical excision procedure (LEEP) to treat cervical intraepithelial neoplasia (CIN) in a low-resource setting.

Methods

Women participating in a cervical screening study in India with histologically confirmed CIN unsuitable for cryotherapy were advised to undergo LEEP. One year after treatment the cervix was visually inspected with acetic acid, followed by colposcopy and biopsy taken from abnormal areas. Cure was defined as no clinical or histologic evidence of CIN. Factors influencing cure rates were evaluated by ^χ2 tests.

Results

Of the 311 women who underwent LEEP, 283 reported for 1-year follow-up and 248 (87.6%) were disease free. Cure rates were 93.0% for CIN 1, 85.5% for CIN 2, and 72.7% for CIN 3. Minor adverse effects were observed in 34 women and complications were seen in 5 women.

Conclusion

LEEP was associated with minimal complications and acceptable cure rates in a low-resource setting, although women with larger lesions had lower cure rates.     

家庭干预在精神分裂症患者社会功能障碍康复中的效果分析

目的分析精神分裂症患者社会功能障碍的现状并探讨家庭干预对其康复效果的影响。方法分析我院门诊收治的128例精神分裂症患者入院治疗前的社会功能状况;患者出院后,将患者随机分为家庭干预组和对照组各64例;对照组给予常规精神病药物维持治疗,干预组在此基础上给予家庭干预治疗1年,并采用社会功能缺陷量表（SDSS）及康复状态量表（MRSS）评估患者的治疗效果;并观察患者的服药依从性及病情复发情况。结果 120（93.7%）例的患者存在明显的社会功能障碍,集中表现在职业及工作、计划性及责任心、对外界的关心及兴趣方面;家庭干预前两组间SDSS、MRSS评分并无显著差异（P〉0.05）,干预后干预组此两项得分均低于对照组（P〈0.05）;同时干预组的服药依从性、复发率情况均优于对照组（P〈0.05）。结论精神分裂症患者大都存在较为严重的社会功能障碍,家庭干预可以显著提高患者生活质量,改善社会功能,降低复发率。     

Thalassemia Incidence and Treatment in China with Special Reference to Shenzhen City and Guangdong Province

According to the data from different screening studies, thalassemia is the most commonly seen hereditary hemolytic disease in China. The reported prevalence of thalassemia carriers varies but it is most prevalent in Southern China. In the past, the outcome of patients with thalassemia major has been very poor due to unfavorable economic background. With economic improvement in the past 10 years, increasing number of patients can get regular transfusion and chelation, and more patients can be treated by hemopoietic stem cell transplantation. A better prevention network has been built up over the years, but there are still babies being born with severe forms of thalassemia every year. A more comprehensive preventive program and public education are vital.     

Common cancer-related symptoms among GP patients Opportunistic screening in primary health care

Objective - To study the occurrence of symptoms related to the five most common forms of cancer among patients regularly visiting primary care. To estimate the proportion of symptoms needing GP examination, and the number of tumours thus diagnosed. Design - Patients with some form of non-malignant chronic disease received a letter with information about cancer-related symptoms along with an invitation to regular check-up. The letter described the most common symptoms of breast, colorectal, lung, prostate and skin cancers. Setting - 12 health centres in Kalmar County, Sweden. Subjects - 5200 patients aged over 40 years. Results - One patient in 13 reported cancer-related symptoms to the GP. Women reported more symptoms than men, and almost half of them had had symptoms at previous check-ups. The GP was able to explain 7 out of 10 patients' symptoms directly. When other symptoms were examined, 8 cancers were diagnosed as well as 6 pre-malignant tumours, corresponding to 3 tumour diagnoses per 1000 check-ups. Conclusion ? While attending regular check-ups, patients may not report symptoms which cause anxiety and sometimes indicate serious diseases. It is possible to widen the perspective and link both primary and secondary prevention of certain cancers to the check-up.     

The Validity of Ultrasonographic Scanning as Screening Method for Abdominal Aortic Aneurysm

OBJECTIVE: the sensitivity and specificity of screening for abdominal aortic aneurysms (AAAs) with ultrasonographic scanning (US) is unknown. The aim of the study was to validate US as screening test for AAAs. METHODS AND MATERIAL: 4176 (76.3%) of 5470 men aged 65-73 attended hospital-based US screening for an AAA at their local hospital. Two observers and one scanner were used. The maximal anterior-posterior (AP) of the dilated aorta, or 2 cm above the bifurcation, and at the crossing of left renal vein was recorded. In 50 cases, blinded measurements were carried out by two observers. An AAA was defined as an AP diameter greater than 29 mm. RESULTS: the standard deviation (s.d.) of the interobserver variability of the distal AP diameter was 0.84. The mean distal AP diameter was 17. 9 mm (s.d. 2.92). Combining these data, the estimated diagnostic sensitivity was 98.9%, the estimated diagnostic specificity was 99. 9%. The interobserver s.d. of the proximal AP diameter was 1.76. The mean proximal AP diameter was 18.4 mm (s.d. 2.45). Combining these data, the estimated diagnostic sensitivity was 87.4%, the estimated diagnostic specificity was 99.9%. CONCLUSION: US seems to be a valid screening method for AAA. Screening for proximal infrarenal aorta aneurysm remains acceptable because the majority of aortic diameters in this segment are so much smaller than the diameters that define an AAA.