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1.
Hum Vaccin Immunother ; 14(2): 396-403, 2018 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-29211620

RESUMEN

A 9-valent HPV (9vHPV) vaccine has been developed to protect against HPV type 6/11/16/18/31/33/45/52/58-related infection and disease. Previous safety analyses from 7 clinical trials conducted in 9vHPV vaccine recipients 9-26 years of age, including comparisons of 9vHPV and quadrivalent HPV (qHPV) vaccines in girls and women 16-26 years of age, showed that the 9vHPV vaccine was generally well tolerated. Additional safety analyses were conducted to include the results of new clinical studies. The safety profile of the 9vHPV vaccine in prior qHPV vaccine recipients (n = 3756 from 1 randomized controlled trial and 2 open-label extension studies) and young men (n = 248 9vHPV and n = 248 qHPV vaccine recipients from 1 randomized controlled trial) was evaluated. Vaccine was administered as a 3-dose regimen (at Day 1 and Months 2 and 6), and adverse events (AEs) were monitored. The most common AEs were injection-site events (91.1% and 79.0% in prior qHPV vaccine recipients and young men, respectively), the majority of which were mild. Discontinuations due to an AE were rare (0.2% and 0.0% among prior qHPV vaccine recipients and young men, respectively). In young men, the AE profile of the 9vHPV vaccine was generally similar to that of the qHPV vaccine. Overall, the 9vHPV vaccine was generally well tolerated in prior qHPV vaccine recipients and in young men, with an AE profile generally consistent with that previously reported with the broader clinical program.


Asunto(s)
Vacunas contra Papillomavirus/efectos adversos , Vacunas contra Papillomavirus/inmunología , Adolescente , Adulto , Niño , Método Doble Ciego , Femenino , Humanos , Masculino , Infecciones por Papillomavirus/prevención & control , Vacunación/efectos adversos , Adulto Joven
2.
Gynecol Oncol ; 133(2): 159-66, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24631451

RESUMEN

OBJECTIVE: This retrospective registry-based study aimed to assess the human papillomavirus (HPV)-type distribution in primary and recurrent high-grade cervical intraepithelial neoplasia (CIN2+), and to discriminate pre-existing from newly-acquired infections. METHODS: Cervical specimens from 58 women (median age (Q1-Q3): 37.6 (31.7-44.9)) who underwent primary (1998-2003) and repeat conizations were confirmed as CIN2+ during expert pathology review. HPV testing was performed using PCR MP-TS123 Luminex for 16 HPV types. Molecular HPV16 E6 and HPV18 LCR DNA sequencing was performed on specimens with persistent HPV16/18. RESULTS: All 58 paired cones were HPV positive; 49 had CIN3+ in the primary cone. Forty-seven (95.9%) women with primary CIN3+ and recurrent CIN2+ had persistent high-risk (hr) HPV infection, of which 74.5% were HPV16/18. Two women had probable newly-acquired HPV16/52/56 and HPV39 infections. One woman with persistent HPV52 also had a probable new HPV16 E6 variant in the recurrent CIN2+. Median time delay (Q1-Q3) between conizations was 2.0 years (1.1-4.0), being shorter for women older than 40 years: 2.6 years (1.1-3.7) than for women younger than 40 years: 6.0 years (2.0-8.7). Primary conization histology revealed CIN3, cervical adenocarcinoma in situ and microinvasive carcinomas in 43 (87.8%), 5 (10.2%) and 1 (2.0%) women, respectively. Primary HPV16- and HPV18-infected CIN3+ had a shorter delay between conizations: 1.8years (1.2-4.4) and 2.2 years (0.4-NE), respectively, compared to HPV33-: 3.8 years (3.3-7.8) or other HPV type-infected: 8.2 years (6.0-NE) CIN3+. CONCLUSIONS: Routine post-conization hr-HPV DNA testing together with cervical cytology may provide a better prediction for potential recurrent disease. Further, primary prevention through adolescent vaccination may prevent CIN2+ and its recurrence.


Asunto(s)
Alphapapillomavirus/genética , ADN Viral/análisis , Recurrencia Local de Neoplasia/virología , Infecciones por Papillomavirus/virología , Displasia del Cuello del Útero/virología , Neoplasias del Cuello Uterino/virología , Adulto , Anciano , Conización , Femenino , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Noruega , Sistema de Registros , Estudios Retrospectivos , Análisis de Secuencia de ADN , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía , Displasia del Cuello del Útero/patología
3.
Obstet Gynecol ; 115(5): 962-968, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20410769

RESUMEN

OBJECTIVE: To evaluate medical abortion as a treatment alternative for late first-trimester abortions and to evaluate the decrease in beta-hCG after abortion at 63-90 days of gestation. METHODS: All women received mifepristone 200 mg orally, followed by 800 micrograms misoprostol vaginally 48 hours later. Misoprostol was repeated every 3 hours orally, to a maximum of five doses if needed. A clinical examination including ultrasonography was performed 8-14 days after treatment. beta-hCG level was determined before treatment and at follow-up. RESULTS: A total of 254 pregnant women with gestational age 63 to 90 days were included. The successful termination rate was 91.7%. Surgical evacuation was carried out in 21 (8.3%) women. Most women (91.0%) found the method of treatment highly acceptable. The beta-hCG levels of women with successful termination had decreased more than 97.5% at follow-up. CONCLUSION: Medical abortion is an effective and acceptable method for termination of pregnancy in late first trimester.


Asunto(s)
Abortivos no Esteroideos/administración & dosificación , Abortivos Esteroideos/administración & dosificación , Aborto Inducido/métodos , Mifepristona/administración & dosificación , Misoprostol/administración & dosificación , Adolescente , Adulto , Estudios de Casos y Controles , Gonadotropina Coriónica Humana de Subunidad beta/sangre , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Primer Trimestre del Embarazo , Adulto Joven
4.
J Eur Acad Dermatol Venereol ; 23(10): 1147-55, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19453788

RESUMEN

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.


Asunto(s)
Adenocarcinoma/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Displasia del Cuello del Útero/prevención & control , Neoplasias del Cuello Uterino/prevención & control , Adolescente , Adulto , Femenino , Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18 , Humanos , Placebos , Ensayos Clínicos Controlados Aleatorios como Asunto , Parejas Sexuales , Adulto Joven
5.
Br J Cancer ; 95(11): 1459-66, 2006 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-17117182

RESUMEN

Human papillomavirus (HPV) causes cervical, vulvar, and vaginal cancers, precancerous dysplasia, and genital warts. We report data for the longest efficacy evaluation to date of a prophylactic HPV vaccine. In total, 552 women (16-23 years) were enrolled in a randomised, placebo-controlled study of a quadrivalent HPV 6/11/16/18 L1 virus-like-particle vaccine with vaccination at months 0, 2, and 6. At regular intervals through 3 years, subjects underwent gynaecologic examination, cervicovaginal sampling for HPV DNA, serum anti-HPV testing, and Pap testing, with follow-up biopsy as indicated. A subset of 241 subjects underwent two further years of follow-up. At 5 years post enrollment, the combined incidence of HPV 6/11/16/18-related persistent infection or disease was reduced in vaccine-recipients by 96% (two cases vaccine versus 46 placebo). There were no cases of HPV 6/11/16/18-related precancerous cervical dysplasia or genital warts in vaccine recipients, and six cases in placebo recipients (efficacy = 100%; 95% CI:12-100%). Through 5 years, vaccine-induced anti-HPV geometric mean titres remained at or above those following natural infection. In conclusion, a prophylactic quadrivalent HPV vaccine was effective through 5 years for prevention of persistent infection and disease caused by HPV 6/11/16/18. This duration supports vaccination of adolescents and young adults, which is expected to greatly reduce the burden of cervical and genital cancers, precancerous dysplasia, and genital warts.


Asunto(s)
Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/inmunología , Vacunas contra Papillomavirus/uso terapéutico , Neoplasias del Cuello Uterino/prevención & control , Virión/inmunología , Adolescente , Adulto , Alphapapillomavirus/inmunología , Anticuerpos Antivirales/sangre , Condiloma Acuminado/prevención & control , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Infecciones por Papillomavirus/epidemiología , Displasia del Cuello del Útero/prevención & control , Frotis Vaginal
6.
Clin Microbiol Infect ; 12(8): 761-8, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16842571

RESUMEN

This report describes a new PCR-based assay for the detection of Pseudomonas aeruginosa genotype D in occupational saturation diving systems in the North Sea. This genotype has persisted in these systems for 11 years (1993-2003) and represents 18% of isolates from infections analysed during this period. The new PCR assay was based on sequences obtained after randomly amplified polymorphic DNA (RAPD)-PCR analysis of a group of isolates related to diving that had been identified previously by pulsed-field gel electrophoresis (PFGE). The primer set for the D genotype targets a gene that codes for a hypothetical class 4 protein in the P. aeruginosa PAO1 genome. A primer set able to detect P. aeruginosa at the species level was also designed, based on the 23S-5S rDNA spacer region. The two assays produced 382-bp and 192-bp amplicons, respectively. The PCR assay was evaluated by analysing 100 P. aeruginosa isolates related to diving, representing 28 PFGE genotypes, and 38 clinical and community P. aeruginosa isolates and strains from other species. The assay identified all of the genotype D isolates tested. Two additional diving-relevant genotypes (TP2 and TP27) were also identified, as well as three isolates of non-diving origin. It was concluded that the new PCR assay is a useful tool for early detection and prevention of infections with the D genotype.


Asunto(s)
Reacción en Cadena de la Polimerasa/métodos , Pseudomonas aeruginosa/aislamiento & purificación , ADN Bacteriano/aislamiento & purificación , Genotipo , Pseudomonas aeruginosa/clasificación , Pseudomonas aeruginosa/genética , Técnica del ADN Polimorfo Amplificado Aleatorio , Sensibilidad y Especificidad
7.
Acta Anaesthesiol Scand ; 50(3): 358-63, 2006 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-16480471

RESUMEN

BACKGROUND: The use of regional anesthesia for elective Cesarean section has been demonstrated to be safe for both the mother and new-born. In parturients with an epidural catheter placed previously for labor analgesia, extension of the epidural block may be the preferred option, provided that adequate speed of onset and adequate surgical anesthesia are obtained. We therefore performed a prospective, randomized, double-blind trial to examine the speed of onset and anesthetic quality of 2-chloroprocaine vs. a solution of lidocaine with one additive, epinephrine 5 microg/ml. METHODS: Forty ASA I patients, scheduled for elective Cesarean section, were randomly assigned to two groups: the 2-chloroprocaine group received 2-chloroprocaine 30 mg/ml and the lidocaine group received the same amount (ml) of lidocaine 20 mg/ml with 5 microg/ml epinephrine. The speed of onset was defined as the time taken to loss of cold sensation from 70% ethanol application at thoracic dermatome level 5 (Th5). RESULTS: The time to achieve loss of cold sensation at Th5 was similar in both groups: median of 8 min (range, 4-13 min) in the 2-chloroprocaine group vs. 5 min (range, 2-22 min) in the lidocaine group (NS). Epidural anesthesia was successful for surgery in all but one patient (lidocaine group). There was no significant difference in the need for supplemental intravenous alfentanil between the two groups: 30% vs. 20% of patients in the 2-chloroprocaine and lidocaine groups, respectively; the pain scores (visual analog scale) were also similar. Intra-operative complications occurred with similar frequency, and none was serious. In the patients in the 2-chloroprocaine group, 11 (55%) had episodes of systolic blood pressure less than 90 mmHg vs. 15 (75%) in the lidocaine group (NS). CONCLUSION: Both 2-chloroprocaine and lidocaine have a rapid onset of effect and are suitable local anesthetic agents for Cesarean section. In view of the time taken for preparation and the potential for logistic problems when an additive is used, a pre-prepared solution, such as 2-chloroprocaine, may be preferred.


Asunto(s)
Anestesia Epidural , Anestesia Obstétrica , Anestésicos Locales/administración & dosificación , Epinefrina/administración & dosificación , Lidocaína/administración & dosificación , Procaína/análogos & derivados , Adulto , Cesárea , Método Doble Ciego , Femenino , Humanos , Hipotensión/etiología , Embarazo , Procaína/farmacología , Estudios Prospectivos , Factores de Tiempo
8.
Br J Cancer ; 92(5): 895-905, 2005 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-15726105

RESUMEN

Ovarian cancer spreads intraperitoneally and forms fluid, whereby the diagnosis and therapy often become delayed. As the complement (C) system may provide a cytotoxic effector arm for both immunological surveillance and mAb-therapy, we have characterised the C system in the intraperitoneal ascitic fluid (AF) from ovarian cancer patients. Most of the AF samples showed alternative and classical pathway haemolytic activity. The levels of C3 and C4 were similar to or in the lower normal range when compared to values in normal sera, respectively. However, elevated levels of C3a and soluble C5b-9 suggested C activation in vivo. Malignant cells isolated from the AF samples had surface deposits of C1q and C3 activation products, but not of C5b-9 (the membrane attack complex; MAC). Activation could have become initiated by anti-tumour cell antibodies that were detected in the AFs and/or by changes on tumour cell surfaces. The lack of MAC was probably due to the expression of C membrane regulators CD46, CD55 and CD59 on the tumour cells. Soluble forms of C1 inhibitor, CD59 and CD46, and the alternative pathway inhibitors factor H and FHL-1 were present in the AF at concentrations higher than in serum samples. Despite the presence of soluble C inhibitors it was possible to use AF as a C source in antibody-initiated killing of ovarian carcinoma cells. These results demonstrate that although the ovarian ascitic C system fails as an effective immunological surveillance mechanism, it could be utilised as an effector mechanism in therapy with intraperitoneally administrated mAbs, especially if the intrinsic C regulators are neutralised.


Asunto(s)
Ascitis/fisiopatología , Proteínas del Sistema Complemento/metabolismo , Neoplasias Ováricas/fisiopatología , Adenocarcinoma/sangre , Adenocarcinoma/fisiopatología , Adulto , Anciano , Anticuerpos Monoclonales , Ascitis/sangre , Antígenos CD59/sangre , Línea Celular Tumoral , Complemento C3/metabolismo , Complemento C4/metabolismo , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Persona de Mediana Edad , Neoplasias Ováricas/sangre
9.
Int J Gynecol Cancer ; 14(5): 957-65, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15361209

RESUMEN

Studies, to date, have suggested that there are distinct molecular differences between microsatellite stable (RER(-)) and unstable (RER(+)) solid tumors, such as colorectal carcinoma. We investigated a range of molecular events including mutation frequency of K-ras, microsatellite instability within the coding region of TGF-beta RII, BAX, and IGF-IIR, loss of expression of p53, hMLH1, hMSH2, hMSH6, and PTEN, and methylation of hMLH1, hMSH2, and PTEN within a large population-based series of sporadic endometrial carcinomas to establish whether there are distinct differences between replication error repair (RER(+)) and RER(-) cases. RER(+) endometrial carcinomas tended to be diploid with normal p53 expression, compared with RER(-) cases. Mutations in TGF-beta RII, IGF-IIR, and BAX were rare, but there was a strong association between mutation and RER(+) status. Methylation and loss of hMLH1 expression were significantly more common in RER(+) cases, as was methylation of PTEN. K-ras mutations were equally frequent in RER(+) and RER(-) cases. Despite the absence of distinct clinicopathological differences between RER(+) and RER(-) cases in this series of sporadic endometrial carcinomas, our results confirm that there are molecular differences between RER(+) and RER(-) cases, but the molecular events occurring in RER(+) endometrial carcinomas differ from those seen in RER(+) colorectal carcinomas.


Asunto(s)
Carcinoma/genética , Neoplasias Endometriales/genética , Genes ras , Repeticiones de Microsatélite/genética , Proteínas Adaptadoras Transductoras de Señales , Disparidad de Par Base , Carcinoma/patología , Proteínas Portadoras , Metilación de ADN , Análisis Mutacional de ADN , Reparación del ADN , Neoplasias Endometriales/patología , Femenino , Humanos , Inmunohistoquímica , Homólogo 1 de la Proteína MutL , Proteínas de Neoplasias , Proteínas Nucleares
10.
Eur J Anaesthesiol ; 21(10): 776-80, 2004 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15678731

RESUMEN

BACKGROUND AND OBJECTIVE: In 1991 general anaesthesia was used extensively for emergency Caesarean section at Haukeland University Hospital even in patients with an ongoing epidural infusion. With increased knowledge of the potential safety benefits of regional anaesthesia and increased experience with the technique, we decided to use indwelling epidural catheters for emergency Caesarean section. METHODS: We conducted a retrospective analysis of a full annual data set on emergency Caesarean section in parturients with ongoing epidural analgesia in 1997 and compared it with a similar data set from 1991. RESULTS: Epidural anaesthesia was used significantly more often in 1997 with 115 (78%) cases than in 1991 with five (12%) cases (P < 0.001). Elapsed time before adequate anaesthesia and the start of surgery was significantly shorter in 1991 (mean 8.3 min) compared to 1997 (mean 13 min) (P < 0.001). No deaths or major complications were observed in either group. Intraoperative minor complications were observed more frequently in 1997 with 70 cases (47%) than in 1991 with two cases (6%) (P < 0.001). The principal complications were hypotension and nausea. Postoperative complications in mother and neonate were similar in both groups. There was a significantly shorter mean hospital stay in 1997 (6 days), compared with 1991 (8 days) (P < 0.001). CONCLUSION: The increase in the use of indwelling epidural catheters for emergency Caesarean section has resulted in a significant increase in the use of regional anaesthesia. A modest increase in time elapsed before start of surgery was observed although there were no significant differences in the number of neonates with low Apgar scores. No major complications were observed, but there was an increased frequency of minor complications in 1997.


Asunto(s)
Anestesia Epidural , Anestesia Obstétrica , Cesárea , Analgesia Epidural , Anestesia Epidural/efectos adversos , Anestesia Obstétrica/efectos adversos , Puntaje de Apgar , Catéteres de Permanencia , Urgencias Médicas , Femenino , Humanos , Embarazo
11.
Ann Occup Hyg ; 47(3): 227-33, 2003 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12639836

RESUMEN

INTRODUCTION: Skin infections in saturation diving are caused by microbes that flourish in saturation environments. Improvements in the prevention of infections must therefore be based on environmental control and elimination. Furthermore, only a few genotypes seem to be responsible for the majority of infections in the Norwegian sector of the North Sea, and these have all been demonstrated in saturation systems for many years. Although reservoirs of infectious genotypes have been identified, their true sources have not been identified. OBJECTIVES: The purpose of this field study was to log the contamination by Pseudomonas aeruginosa of the saturation system throughout a diving operation. MATERIALS AND METHODS: Daily water samples from the vessels drinking water system and from the heated seawater systems to divers suits were taken throughout the diving period of 1 month in the summer of 2001. All P.aeruginosa isolates were genotyped by pulsed field gel electrophoresis. RESULTS: A total of 17 P.aeruginosa genotypes were identified in the course of this field study. None of the most common infectious genotypes previously observed in the Norwegian sector were among these strains. Two genotypes were involved in skin infections during the period of operation: TP2 and TP12. TP2 was shown to be an inhabitant of the diving systems throughout the investigation period, while TP12 was introduced from seawater in the course of the operation and rapidly spread and established itself throughout the diving system. CONCLUSIONS: The study has demonstrated seawater as a true source of an infectious P.aeruginosa genotype in occupational diving systems.


Asunto(s)
Buceo , Enfermedades Profesionales/microbiología , Exposición Profesional , Infecciones por Pseudomonas/microbiología , Agua de Mar/microbiología , Enfermedades Cutáneas Bacterianas/microbiología , ADN Bacteriano/análisis , Humanos , Noruega , Pseudomonas aeruginosa
12.
Acta Obstet Gynecol Scand ; 80(11): 1056-61, 2001 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-11703208

RESUMEN

OBJECTIVES: Medical abortion was first introduced in Norway in April 1998. The aims of this study were to assess the efficacy, side effects, and acceptability of medical abortion using mifepristone orally and misoprostol vaginally in a Norwegian population. DESIGN: The study included the first 226 pregnant women with gestational age of <63 days who requested nonsurgical abortion during the first year in the first Norwegian hospital using this regimen. METHODS: All women received a single dose of mifepristone 600 mg orally, followed at 48 hours by 800 microg misoprostol vaginally. Treatment outcome and complications were the principal outcome measures. We also measured the rates of side effects such as abdominal pain and bleeding and the women's acceptability of treatment. RESULTS: Abortion was successful in 95%, surgical evacuation became necessary in 4%, and the pregnancy continued in one woman. During the study period the method was chosen by 23% of those requesting abortion before 63 days amenorrhea; 80% would use the method again; 81% would recommend it to a friend; in retrospect, 69% would not have been willing to be randomly allocated to either a medical or a surgical method. CONCLUSIONS: The combination of orally administrated mifepristone and vaginally administrated misoprostol is an abortion method that is both effective and safe, has few side effects and is well accepted by Norwegian women.


Asunto(s)
Abortivos no Esteroideos/uso terapéutico , Abortivos Esteroideos/uso terapéutico , Aborto Inducido/métodos , Mifepristona/uso terapéutico , Misoprostol/uso terapéutico , Abortivos no Esteroideos/administración & dosificación , Abortivos Esteroideos/administración & dosificación , Aborto Inducido/psicología , Acetaminofén/administración & dosificación , Adolescente , Adulto , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Codeína/administración & dosificación , Femenino , Humanos , Mifepristona/administración & dosificación , Misoprostol/administración & dosificación , Noruega , Dimensión del Dolor , Satisfacción del Paciente , Embarazo , Primer Trimestre del Embarazo , Resultado del Tratamiento
13.
Maturitas ; 39(1): 83-90, 2001 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-11451625

RESUMEN

OBJECTIVES: To describe and compare attitudes, knowledge and management strategies concerning the prescription of hormone replacement therapy (HRT) between gynecologists from three Scandinavian countries. DESIGN AND METHODS: In a cross-sectional study gynecologists in Denmark (n=386), Norway (n=475) and Sweden (n=1323) were invited by letter to complete and return an enclosed questionnaire. Then 1653 of the 2184 (76%) contacted gynecologists completed and returned the questionnaire. RESULTS: of the 1653 Scandinavian gynecologists, 42% offered HRT to all women provided there was no contraindication, while 58% recommended HRT to selected women after considering the advantages and disadvantages of HRT. In Norway and Sweden, the proportion of gynecologists routinely prescribing HRT for women without contraindications increased with age and in the oldest age group of gynecologists (>55 years) 49 and 56%, respectively, recommended HRT to all women. The gynecologists were unanimous in their choice of the type of HRT for perimenopausal women as 94% preferred cyclical or sequential combined (estrogen/progestogen) treatment or estrogen monotherapy (orally or transdermally) for hysterectomized women (95%). For postmenopausal women, 75% of the gynecologists offered continuous combined HRT while cyclical combined therapy was chosen by 15% of the gynecologists. No significant differences were found between physicians in the three countries regarding indications and contraindications to HRT. CONCLUSIONS: Scandinavian gynecologists are generally well informed concerning HRT and liberally recommend HRT for women without contraindications.


Asunto(s)
Ginecología/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Terapia de Reemplazo de Hormonas/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Dinamarca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Encuestas y Cuestionarios , Suecia
14.
Scand J Infect Dis ; 33(6): 413-9, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11450859

RESUMEN

Skin infection caused by Pseudomonas aeruginosa is the most frequent health problem associated with occupational saturation diving on the Norwegian continental shelf. In the course of 14-y surveillance of infection and environmental control in occupational offshore saturation diving systems, a collection of approximately 1000 P. aeruginosa isolates has been amassed. Retrospective genomic analyses using restriction enzyme fragmentation and pulsed-field gel electrophoresis have identified 24 of 76 environmental P. aeruginosa genotypes as being of significance for single infections, outbreaks of infections and recurrent skin infections in occupational diving systems. In addition, these genomic analyses have made it possible to separate outbreaks of infection into outbreaks with 1 single genotype and clusters of infections where different genotypes are involved. We conclude that the established, assumed diver-to-diver contagion vector ought to be replaced by a environmental contagion vector as the most likely vector within these specific occupational environments. Furthermore, consecutive presence of the frequent environmental/infectious genotypes demands specific improvement of infection prevention and control in these systems.


Asunto(s)
Buceo/efectos adversos , Exposición Profesional/efectos adversos , Infecciones por Pseudomonas/genética , Pseudomonas aeruginosa , Enfermedades Cutáneas Bacterianas/genética , Análisis por Conglomerados , ADN Bacteriano/análisis , Brotes de Enfermedades , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Incidencia , Noruega/epidemiología , Polimorfismo de Longitud del Fragmento de Restricción , Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/aislamiento & purificación , Recurrencia , Estudios Retrospectivos , Enfermedades Cutáneas Bacterianas/epidemiología
16.
Acta Obstet Gynecol Scand ; 80(5): 409-12, 2001 May.
Artículo en Inglés | MEDLINE | ID: mdl-11328216

RESUMEN

BACKGROUND: The aim of the study was to find the incidence and clinical implications of peripartum hysterectomy in our department and to identify women at risk to improve treatment before resorting to hysterectomy. MATERIAL AND METHODS: In the period 1981-1996, cases with peripartum hysterectomy among a total of 70,546 deliveries in our department were identified from three different sources. The clinical variables were obtained by review of the maternal records. RESULTS: In the study period, 11 cases, representing an incidence of 0.2 peripartum hysterectomies per 1000 deliveries was found. Eight women had a cesarean section and three women had a spontaneous vaginal delivery. Six of the patients had previous operation on the uterus. The indication for hysterectomy was atony in seven, suspected rupture in two, placenta accreta in one and DIC in one woman. The maternal morbidity was substantial as the mean number of transfusions given was 15 units (range 7-24), and the mean hospitalization time was 15 days (range 11-29). There was no maternal mortality, but one infant died due to asphyxia caused by placental abruption. CONCLUSIONS: The incidence of peripartum hysterectomy was low, but the condition is serious with significant maternal morbidity.


Asunto(s)
Histerectomía/estadística & datos numéricos , Complicaciones del Trabajo de Parto/epidemiología , Femenino , Humanos , Incidencia , Registros Médicos , Noruega/epidemiología , Complicaciones del Trabajo de Parto/cirugía , Hemorragia Posparto/epidemiología , Hemorragia Posparto/cirugía , Periodo Posparto , Embarazo , Estudios Retrospectivos , Factores de Riesgo
17.
BJOG ; 108(3): 248-53, 2001 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11281463

RESUMEN

OBJECTIVE: To determine the occurrence of high venous velocities at the umbilical ring in the normal early second trimester, based on the assumption that a narrow umbilical ring may cause obstruction and increased venous blood velocity at the abdominal wall. DESIGN: Cross-sectional study. SETTING: Hospital antenatal clinic. POPULATION: One hundred and one low risk singleton pregnancies specifically recruited for the study. METHODS: Ultrasound was used at 11-19 weeks to determine the diameter and velocity in the umbilical vein at the fetal end of the cord and at the inlet through the abdominal wall. Outcome measures 10th, 50th and 90th centiles were estimated for the time-averaged maximum velocity in the cord and at the abdominal inlet. The increase of velocity as the blood entered the abdominal wall was calculated in percent of the velocity in the cord. RESULTS: During weeks 11-12 there was hardly any difference between blood velocity in the umbilical vein at the umbilical ring and that in the cord. From week 13 onwards it was increasingly common to find blood acceleration at the umbilical ring of 50-500%. Velocity increment >50% was found in 0/12 fetuses (0%) at 11-12 weeks, 5/20 (25%) at 13-14 weeks, and in 21/28 (75%) at 17-19 weeks. CONCLUSIONS: Blood velocity is higher in the umbilical vein at the abdominal wall than the cord, particularly after 13 weeks of gestation. If acceleration of blood velocity at the umbilical ring is a sign of a narrow inlet, it seems that a progressive tightening occurs during the second trimester.


Asunto(s)
Cordón Umbilical/irrigación sanguínea , Venas Umbilicales/fisiología , Músculos Abdominales , Velocidad del Flujo Sanguíneo/fisiología , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Embarazo , Segundo Trimestre del Embarazo , Ultrasonografía Prenatal , Cordón Umbilical/embriología , Venas Umbilicales/embriología
18.
Tidsskr Nor Laegeforen ; 121(28): 3286-91, 2001 Nov 20.
Artículo en Noruego | MEDLINE | ID: mdl-11826459

RESUMEN

BACKGROUND: Antiprogestins, agents that inhibit the action of progesterone, are among the most controversial and yet the more interesting therapeutic compounds developed over the past 20 years. MATERIAL AND METHODS: We present a review of the literature identified through limited searches on Medline, Cochrane and the Internet, with a discussion of the biological, clinical, political and ethical aspects of this important drug. RESULTS: The first effective antiprogestin in clinical use was mifepristone (also known as RU 486). This agent provides the most effective and safest means of medical abortion. It may also be used as a contraceptive and delivery-inducing agent and in the treatment of spontaneous abortion, ectopic pregnancies, leiomyoma, endometriosis, intrauterine fetal death, Cushing's syndrome and progesterone-dependent malignancies. INTERPRETATION: The introduction of mifepristone as an abortion-inducing agent has created intense political, ethical and moral controversies which have delayed clinical investigations and evaluations for potential expanded use.


Asunto(s)
Abortivos Esteroideos , Anticonceptivos Sintéticos Orales , Antagonistas de Hormonas , Mifepristona , Abortivos Esteroideos/administración & dosificación , Abortivos Esteroideos/química , Abortivos Esteroideos/historia , Anticonceptivos Sintéticos Orales/administración & dosificación , Anticonceptivos Sintéticos Orales/historia , Femenino , Enfermedades de los Genitales Femeninos/tratamiento farmacológico , Historia del Siglo XX , Antagonistas de Hormonas/administración & dosificación , Antagonistas de Hormonas/historia , Humanos , Trabajo de Parto Inducido , Mifepristona/administración & dosificación , Mifepristona/química , Mifepristona/historia , Neoplasias/tratamiento farmacológico , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Receptores de Progesterona/efectos de los fármacos
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