bluuebunny/crossref_metadata_2025 huggingface dataset:
Fungal rhinosinusitis
Authors: Lund V. J. , Lloyd G. , Savy L. , Howard D.
Published: October 2002

Fungal infections in both their invasive and non-invasive forms can prove difficult to diagnose. The often characteristic appearances on imaging are of great assistance. CT is the primary imaging modality and is probably more accurate than MRI in diagnostic specificity and determining the extent of bone erosion. However this may require a modified scanning technique to adequately demonstrate the typical soft tissue density variations of fungi. MRI should be used to supplement CT when intra-cranial or intra-orbital extension is suspected.
Nasal non-Hodgkin’s lymphoma causing mucocele of the maxillary antrum
Authors: Raj P. , Mohanradja D. , Siddiq M. A. , Stansbie J. M.
Published: October 2002

The authors report a case of an antral mucocele secondary to obstruction of the antral ostium by a non-Hodgkin’s lymphoma. Antral mucoceles are rare, and this is the first report of one such caused by a nasal lymphoma.
Cavernous haemangioma of the nasal bones: an alternative management option
Authors: Webb C. J. , Porter G. , Spencer M. G. , Sissons G. R. J.
Published: October 2002

The authors present a case of bilateral cavernous haemangiomas affecting the posterior ends of both inferior turbinates of the nose. The condition was treated by angiographically controlled embolization. Review of the literature back to 1967 has revealed no other report of embolization being used specifically for this condition. All previous treatments have involved surgery; we describe an alternative therapeutic option.
Late scar recurrence in mucoepidermoid carcinoma of base of tongue
Authors: Varghese Bipin T. , Jacob M. M. , Madhavan Jayaprakash , Nair M. Krishnan
Published: October 2002

Recurrence in mucoepidermoid carcinoma of the salivary gland after 15 years is rare and present difficult therapeutic decisions. A rare case of mucoepidermoid cancer of the base of the tongue that recurred locoregionally after 20 years and was managed judiciously by a planned combined modality approach is presented.
A systematic approach to interpretation of computed tomography scans prior to surgery of middle	ear cholesteatoma
Authors: Watts Simon , Flood Liam Martin , Clifford Kevin
Published: October 2002

The foundation of mastoid surgery for cholesteatoma has traditionally been a thorough knowledge of the anatomy and familiarity with landmarks, constant alertness to detect unsuspected complications and the experience to tailor the surgery to the pathology encountered. Whilst not indispensable, computed tomography (CT) scanning is a useful adjunct whose potential predictive value is only truly appreciated by skilled interpretation. We present a guide to analysis to maximize the value of pre-operative radiology.
When a mastoid swelling is not mastoiditis
Authors: Hung T. , Huchzermeyer P.
Published: October 2002

A case is reported of swelling over the mastoid process due to subgaleal abscess possibly secondary to trivial cutaneous trauma. The diagnosis was difficult as subgaleal abscess is an extremely rare condition especially after the advent of the antibiotic era. The route of entry of the infection to the subgaleal space was unclear as there was no skin puncture. The absence of substantial trauma excluded subgaleal haematoma as a precondition. We would like to discuss the possible aetiologies and the management of this rare case in the light of the limited information available in the world literature.
Maxillary sinus polyps secondary to dental extraction
Authors: Skladzień J. , Litwin J. A. , Nowogrodzka-Zagó M. , Wierzchowski W.
Published: October 2002

Polyps of the maxillary sinus were obtained from six patients who had reported upper tooth extraction with oroantral perforation prior to the development of symptoms, from 11 patients with chronic sinusitis, and from 12 patients with allergy. Histopathological features, scanning electron microscopy of the polyp epithelium and clinical data were compared in those groups of patients. The post-traumatic polyps differed from those of other aetiologies by showing the presence of granulomas, less numerous inflammatory cells with very few eosinophils, nearly normal surface epithelium (smaller surface area occupied by nonciliated epithelium, absence of epithelial squamous cells, normal frequence of goblet cells), rapid appearance of symptoms, and shorter duration of the disease. It seems that the specific characteristics of the injury-induced polyps results from a different mechanism of their formation, involving primarily abnormal mucosal repair and to a lesser extent an inflammatory process.
Clinico-pathological correlation between allergic rhinitis and bronchial asthma
Authors: Varghese Bipin T. , Murthy P. S. N. , Rajan Ranjit
Published: October 2002

A prospective study was carried out on 52 patients with allergic rhinitis, during March 1993–January 1995. This was to analyse the occurrence of bronchial asthma among them and to correlate the symptoms, signs and pathological findings of allergic rhinitis with that of bronchial asthma in those patients with both the disorders. The therapeutic benefits with regard to the symptoms of bronchial asthma in these patients were assessed after treatment of their nasal allergy for a period of at least four months.

A definite aetio-clinico-pathological correlation could be established between allergic rhinitis and bronchial asthma and it could be concluded from the study that prompt attention to nasal symptoms in cases with co-existent bronchial asthma helps to a large extent in curbing the symptoms of the latter.
Human auricolar myiasis caused by Wohlfartia magnifica (Schiner) (Diptera: Sarcophagidae): first case found in Sardinia
Authors: Panu F. , Cabras G. , Contini C. , Onnis D.
Published: October 2002

The authors report a case of myiasis of the middle ear caused by Wohlfartia magnifica Schiner (Diptera: Sarcophagidae). The entomological aspects, the clinical epidemiological characteristics and the therapeutic solutions of this disease are evaluated. In particular, they underline the rarity of myiasis both because of the aetiologic agent and the anatomical site. The therapeutic aspects are also reported and discussed.
Oesophageal ulceration caused by doxycycline: an unusual complication
Authors: Ullah R. , Golchin K. , Hampton S. , Primrose W. J.
Published: October 2002

Oesophageal ulceration is an unusual complication of doxycycline treatment (Vibramycin®) presenting to an Otorhinolaryngology department. A case report is presented with discussion of investigations and management of the patient.
Primary sinonasal amyloidosis
Authors: Tsikoudas A. , Martin-Hirsch D. P. , Woodhead C. J.
Published: October 2002

Primary amyloidosis localized to the sinonasal tract is extremely rare with only 20 reported cases in the English literature. We describe a further case and review the literature.
Post-nasal space oncocytoma: a different approach to a rare tumour
Authors: Colreavy Michael P. , Sigston Elizabeth , Lacy Peter D. , Balasubramaniam Gnaneswary S. , Lyons Bernard M.
Published: October 2002

Oncocytomas are rare tumours that occur predominantly in the major salivary glands, particularly the parotid of older individuals. We present the exceptionally rare occurrence of an oncocytoma in the post-nasal space and its treatment for the first time via a Le Fort I osteotomy. The potential for local spread to the surrounding skull base makes it vital to achieve good oncological clearance. We found that this was possible using the Le Fort I technique and would recommend that this approach should be considered in future, when approaching such lesions.
Haemangiopericytoma of infratemporal fossa
Authors: Kanazawa Takeharu , Nishino Hiroshi , Miyata Mamoru , Kuriki Ken , Abe Kouichi , Ichimura Keiichi
Published: October 2002

Haemangiopericytomas (HPCs) are rare vascular tumours that commonly involve the soft tissues of the trunk and lower extremities. In the head and neck, the most common sites are the nasal cavity and the paranasal sinuses, and unusually, the orbital region, the parotid gland, and the neck. We report a patient with HPC that originated in the infratemporal fossa and involved the pterygopalatine and the middle cranial fossae, apparently the first such case to be reported. Although the patient has undergone resection on three separate occasions, the tumour recurred. We then performed an extended resection using the infratemporal fossa approach type D. The patient has shown no recurrence in the past five years.

Although histopathologic confirmation of this malignancy may be difficult, extensive resection remains the most effective treatment in such cases.
Tongue-base hamartoma in tuberous sclerosis
Authors: Wallace Helen , Davis Anne , Spedding Anne
Published: October 2002

This paper describes the case of a 41-year-old female with tuberous sclerosis who persented with a large tongue-base hamartoma. The surgical management of the patient was complicated by the presence of a large thyroid goitre. Awake fibre-optic intubation, thyroidectomy then tracheostomy were necessary before the tongue-base hamartoma could be safely resected. To the best of our knowledge, this is the first reported case of a tongue-base hamartoma in a patient with tuberous sclerosis.
Resident training in head and neck flap reconstruction in U.S. academic otolaryngology programmes
Authors: Bhaya Mahesh H. , Har-El Gady
Published: October 2002

The main objective of this study was to assess resident training in head and neck flap reconstruction, and to determine the confidence of graduating residents in performing these flaps independently. Questionnaires were distributed to otolaryngology residents graduating in 1997. Respondents recorded the number of pedicled and free flap procedures they performed, or assisted with, and indicated flaps they felt confident about performing independently.

Pectoralis major myocutaneous (PMMC) (n = 560, mean 6.59) and radial forearm (RF) (66, 0.78) were the most common pedicled and free flaps performed. There was a significant difference (p = 0.0002, Mann-Whitney U test) between median confidence for pedicled (44.5 per cent) and free flaps (two per cent). Ten of the 17 flaps showed a significant Pearson correlation (p<0.05) between number of procedures performed and confidence in performing them independently. Of the pedicled flaps, latissimus dorsi (LD) showed good correlation (r = 0.67), PMMC showed low correlation (r = 0.19) and other pedicled flaps fair correlation. Of the free flaps, LD (r = 0.64) and fibula (r = 0.50) showed good correlation and rectus abdominis and RF fair correlation. There was a fair inverse correlation (r =−0.29) between numbers of pedicled and free flaps performed.

Higher correlation in flaps uncommonly performed reflects greater operative training necessary to achieve the confidence for performing these flaps independently. As respondents perfomed greater numbers of free flaps, the number of pedicled flaps decreased. It might thus be important to train residents in all aspects of pedicled flaps. Most respondents were of the opinion that additional training in free flaps was necessary for those planning a career in head and neck reconstructive surgery.
Co-existing cholesteatoma and vestibular schwannoma
Authors: Ogungbo Biodun , Holliman Damian , Mendelow A. David , Hill John
Published: October 2002

A 69-year-old man presented with a cholesteatoma in the right mastoid process and a vestibular schwannoma at the left internal acoustic meatus. Cholesteatoma co-existing with a vestibular schwannoma has not been documented previously in the contemporary literature. The clinical dilemma in the managementof his progressive bilateral hearing loss is discussed.

He presented with dizziness and bilateral hearing loss worse on the right side. Pressure over the mastoid process elicited vertigo and nystagmus. He had no history of previous operation or infection in the ear canal. Audiograms confirmed high-tone hearing loss. Radiological investigations revealed a symptomatic cholesteatoma on the right side and an incidental vestibular schwannoma on the left. We have elected to manage bothlesions conservatively.

Bilateral cholesteatoma and bilateral vestibular schwannomas have been previously reported. Co-existing lesions, as in our patient have, however, not been reported previously. The management options of his hearing loss are discussed.
Desmoid tumour of the neck: complete regression following radiation therapy
Authors: Amin Rajni
Published: October 2002

Desmoid tumours are uncommon benign neoplasms. They arise from fascial and musculoaponeurotic tissues and are locally infiltrative, resulting in a high rate of local recurrence following surgical resection. They present difficult loco-regional control. The location and extent of the tumour, as well as the potential for significant morbidity and mortality, dictate the most appropriate therapeutic option. Complete surgical extirpation is the optimal treatment for primary and recurrent desmoid tumours. Radiotherapy isindicated in incompletely excised or recurrent tumours. Radiation as a primary treatment is seldom recommended. A case of desmoid tumour of the neck, primarily treated with radical radiation, is described and relevant literature reviewed.
Disability, handicap and benefit analysis with the bone-anchored hearing aid: the Glasgow hearing aid benefit and difference profiles
Authors: McDermott Ann-Louise , Dutt Sunil N. , Tziambazis Elia , Reid Andrew P. , Proops David W.
Published: October 2002

The Birmingham bone-anchored hearing aid programme began in 1988 and by autumn 2000 a total of 351 patients had been fitted with such an aid. The aim of this study was to assess the effectiveness of hearing rehabilitation with the bone-anchored hearing aid. This was a prospective interview-based questionnaire study carried out in the autumn 2000. A total of 84 adult patients were interviewed. Each patient had worn their BAHA for more than one year.

The questionnaire used during these interviews was the Glasgow hearing aid benefit profile (GHABP) and the Glasgow hearing aid difference profile (GHADP). This was first derived and validated by Gatehouse in 1999. The use of bone-anchored hearing aids was found to reduce the level of disability and handicap and provided the most patient benefit and satisfaction.
Tracheo-innominate artery fistula: a rare complication in a laryngectomized patient
Authors: Hazarika Produl , Kamath Ganesh , Balakrishnan R. , Girish Raj , Harish G. Kundaje
Published: October 2002

A tracheo-innominate artery fistula is an uncommon but frequently fatal complication of tracheostomy. Rarely, it can also occur in laryngectomized patients. We report a post-laryngectomy, post-radiotherapy patient using a metal tracheostomy tube, who developed a tracheo-innominate artery fistula about two months after radiotherapy. To our knowledge this is only the second reported case in a laryngectomized patient. The computed tomography (CT) angiography findings helped confirm the diagnosis and the patient was successfully managed by surgical exploration and ligation of the innominate artery. Coagulase negative Staphylococcus aureus was cultured from a tracheal swab. The clinical features, CT angiography findings, management protocols and possible aetiological factors are discussed.
Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature
Authors: Bhatia K. , Jones N. S.
Published: October 2002

This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.
Acquired idiopathic laryngomalacia treated by laser aryepiglottoplasty
Authors: Siou G. S. , Jeannon J.-P. , Stafford F. W.
Published: October 2002

Laryngomalacia is the most common paediatric airway problem presenting as stridor in the neonate. This congenital anomaly is thought to be caused by inward inspiratory collapse of the supraglottic larynx due to a prolapsed, tall and tubular epiglottis with flaccid aryepiglottic folds. The natural history of this condition usually results in spontaneous resolution by the second year of life. Although acquired cases of adult laryngomalacia have been reported, a search of the literature has yet to show any cases of idiopathic laryngomalacia. We present two cases of idiopathic acquired laryngomalacia in adults.
Schwannoma of the posterior pharyngeal wall
Authors: Huang Chih-Ming , Leu Yi-Shing
Published: October 2002

Schwannoma arising from the posterior pharyngeal wall is extremely rare. We report a 24-year-old female patient who had suffered from dysphagia and discomfort for two months. The tumour was excised completely via the intraoral approach. No recurrence was found after the follow-up period of one year. To our knowledge, only four cases of schwannomas from the posterior pharyngeal wall have been reported, and this patient is the fifth.
The cage preferences of laboratory rats
Authors: Patterson-Kane E. G. , Harper D. N. , Hunt M.
Published: October 2002

Preference tests were used to assess a range of enrichment options for rats kept under standard New Zealand (and similar) caging conditions. The rats did not show significant preferences for most of the options, over an empty cage. The exceptions were shredded paper, a nesting box and a semi-enriched condition incorporating a range of modifications. These cage modifications are recommended for the enrichment of laboratory rats.
PCR-based microsatellite analysis for differentiation and genetic monitoring of nine inbred SENCAR mouse strains
Authors: Benavides F. , Glasscock E. , Coghlan L. G. , Stern M. C. , Weiss D. A. , Conti C. J.
Published: October 2002

Sixteen DNA microsatellites or simple sequence length polymorphisms (SSLPs), generated by polymerase chain reaction (PCR) were selected for use in the genetic quality control of the nine inbred SENCAR strains currently available. The SENCAR strains constitute a powerful tool for mechanistic studies of multi-stage skin carcinogenesis, as well as for studies to understand the underlying genetic basis of resistance to tumour promotion and progression. SSLP analysis is a fast and economical way for detecting genetic contamination (unexpected outcrosses) among these closely-related albino strains, where standard immunological and biochemical markers have been shown to be insufficient.
Interpretation of serological test results for Simian herpes B virus
Authors: Wolfensohn S. E. , Gopal R.
Published: October 2002

In 1992 an annual Simian herpes B virus (BV) screening programme for an experimental group of macaque monkeys ( Macaca mulatta and Macaca fascicularis) was initiated with the aim of establishing a specific pathogen free (SPF) colony. In June 1999 one animal was found to be unexpectedly BV positive (non-negative). The investigation of this result highlights some of the issues and difficulties that may be encountered in such a programme.
Atrichia with papular lesions resulting from mutations in the rhesus macaque (Macaca mulatta) hairless gene
Authors: Ahmad Wasim , Ratterree Marion S. , Panteleyev Andrei A. , Aita Vincent M. , Sundberg John P. , Christiano Angela M.
Published: October 2002

Atrichia with papular lesions (APL) is a rare form of hair loss with an autosomal recessive mode of inheritance that is characterized by the absence of normal hair follicles, and formation of intradermal cystic structures. Mutations in the hairless ( hr) gene in mice and humans have been implicated in the development of this phenotype. Hairless is a putative transcription factor containing a single zinc-finger DNA binding domain, with restricted expression in brain and skin. Here, we describe the complete hr cDNA sequence from the rhesus macaque ( Macaca mulatta) and report the identification of a compound heterozygous mutation in a hairless rhesus macaque born from unrelated parents. Cutaneous biopsy samples from the affected macaque revealed abnormalities, including the replacement of normal hair follicles with dermal cysts and comedones, reminiscent of the skin phenotype observed in hairless mice and humans with APL.
Housing and care of monkeys and apes in laboratories: adaptations allowing essential species-specific behaviour
Authors: Röder E. L. , Timmermans P. J. A.
Published: October 2002

During the last two decades an increasing amount of attention has been paid to the housing and care of monkeys and apes in laboratories, as has been done with the housing and care of other categories of captive animals. The purpose of this review is to develop recommendations for adaptations of housing and care from our knowledge of the daily behavioural activity of monkeys and apes in natural conditions and in enriched laboratory conditions. This review deals mainly with adaptations of daily housing and care with respect to behaviour, and it is restricted to commonly-used species: Callitrichidae ( Callitrix jacchus, Saguinus oedipus); Cebidae ( Aotus trivirgatus, Saimiri sciureus, Cebus apella); Cercopithecidae ( Macaca fascicularis, M. mulatta, M. nemestrina, M. arctoides, Chlorocebus aethiops, Papio hamadryas, P. cynocephalus); Pongidae ( Pan troglodytes).
Perceived compliance with AZT dosing among a sample of African-American drug users
Authors: Williams Mark , Bowen Anne , Ross Michael , Freeman Robert , Elwood William
Published: October 2002

The purpose of this report was to present findings from a pilot study conducted to explore the associations between sociodemographic, drug use, and health belief factors and perceived compliance with zidovudine (AZT) among African-American drug users. Data were collected in Washington, DC, USA from individuals who were African-American; were recent or current drug injectors or crack smokers; were HIV-seropositive, and were receiving treatment for HIV infection. Participants were recruited through local organizations that provide services to HIV-infected persons. Participants were interviewed using a questionnaire that solicited sociodemographic, lifetime and current drug use, current sexual behaviours, health status, HIV and drug treatment history, and health belief data. Analyses were limited to individuals currently using an illicit substance and who had received AZT during their medical treatment. Parametric (Pearson's r) and non-parametric (Spearman's rho) statistics were used to assess correlations between perceived compliance with AZT dosing and independent variables. As the study was intended to be both descriptive and exploratory, the level of statistical significance was set at 0.10, rather than the customary 0.05. Antiretroviral medications recognized and recalled by participants are presented. The most commonly recalled medication was AZT. Slightly less than one-third of participants reported being completely compliant with an AZT regimen. Perceived compliance was found to be negatively associated with 5 variables: age, homelessness, number of injections in the previous 30 days, trading sex for drugs, and the perception that AIDS is no longer a serious disease since the development of new antiretroviral medications. Intensity of feelings of joy, fear, and the belief that taking more anti-HIV medications would result in better health were found to be positively correlated. Bivariate associations between perceived compliance and sociodemographic, drug use, sexual behaviour, and health belief variables suggest further avenues of study and potential points for intervention to increase compliance with antiretroviral medications among racial/ethnic minority drug users receiving treatment for HIV infection.
Exploring the sexual histories of older GUM clinic attenders
Authors: Gott C Merryn , Rogstad Karen E , Riley Vincent , Ahmed-Jushuf Imtyaz , Green Tana
Published: October 2002

Little is known either of the factors motivating clinic attendance in later life, or the sexual health histories of older clinic attenders. A self-administered questionnaire study linked to patient note data aiming to explore these issues was undertaken within 3 genitourinary medicine (GUM) clinics in the Trent region. Participants comprised 224 individuals aged 50 years and older attending the 3 clinics during the study period. The majority of study participants were attending the clinic with a suspected sexually transmitted infection (STI) ( n = 145, 64.7%) and approximately half ( n = 119, 53.1%) were firsttime GUM clinic attenders. Data available for participants recruited from the Sheffield clinic indicated that, although the majority of participants reported having had only one sexual partner during the last 12 months, a significant minority reported considerably higher numbers of partners, including those classed 'higher risk' for STI acquisition. These data indicate that older people engage in behaviours that place them at risk of STI acquisition and many attend GUM clinics for the first time in later life.
A randomized, placebo-controlled trial of monthly azithromycin prophylaxis to prevent sexually transmitted infections and HIV-1 in Kenyan sex workers: study design and baseline findings
Authors: Fonck K , Kaul R , Kimani J , Keli F , MacDonald K S , Ronald A R , Plummer F A , Kirui P , Bwayo J J , Ngugi E N , Moses S , Temmerman M
Published: October 2002

Our objectives were to describe the baseline findings of a trial of antibiotic prophylaxis to prevent sexually transmitted infections (STIs) and HIV-1 in a cohort of Nairobi female sex workers (FSWs). A questionnaire was administered and a medical examination was performed. HIV-negative women were randomly assigned to either one gram azithromycin or placebo monthly. Mean age of the 318 women was 32 years, mean duration of sex work 7 years and mean number of clients was 4 per day. High-risk behaviour was frequent: 14% practised anal intercourse, 23% sex during menses, and 3% used intravenous drugs. While 20% reported condom use with all clients, 37% never use condoms. However, STI prevalence was relatively low: HIV-1 27%, bacterial vaginosis 46%, Trichomonas vaginalis 13%, Neisseria gonorrhoeae 8%, Chlamydia trachomatis 7%, syphilis 6% and cervical intraepithelial neoplasia (CIN) 3%. It appears feasible to access a population of high-risk FSWs in Nairobi with prevention programmes, including a proposed trial of HIV prevention through STI chemoprophylaxis.
Opportunistic testing for chlamydial infection in people attending a sexual medicine clinic for HIV tests
Authors: Dedicoat M , Taylor S , Home J , Wainright R , Hodgkins R , White D , Drake S
Published: October 2002

Patients presenting for an HIV test alone represent an opportunity for screening for Chlamydia trachomatis. This audit was designed to assess the uptake of chlamydial screening by urinary ligase chain reaction (LCR) in adults attending a genitourinary clinic. All patients requesting an HIV test were offered full genital screening in the first audit period, if they declined they were offered chlamydial LCR. During the second period patients who refused full screening were asked to provide a urine sample for LCR testing unless they declined. Nine hundred and forty-two patients presented for HIV tests alone during the first audit period. Two hundred (22%) agreed to provide a urine sample for LCR testing, 7 (3.5%) were positive for chlamydia. During the second audit period 794 patients presented for HIV tests alone, 426 (55.1%) provided urine for LCR testing, 15 (3.4%) were positive. The uptake of urinary LCR, a non-invasive test for a potentially serious infection remained disappointingly low despite changes to the audit protocol. Reasons for this are discussed.
Partner notification of pregnant women infected with syphilis in Nairobi, Kenya
Authors: Gichangi P , Fonck K , Sekande-Kigondu C , Ndinya-Achola J , Bwayo J , Kiragu D , Claeys P , Temmerman M
Published: October 2002

We examined partner notification among syphilitic pregnant women in Nairobi. At delivery, 377 women were found to be rapid plasma reagin (RPR) reactive. Data were available for 94% of the partners of women who were tested during pregnancy; over 67% of the partners had received syphilis treatment while 23% had not sought treatment mainly because they felt healthy. Six per cent of the women had not informed their partners as they feared blame and/or violence. Adverse pregnancy outcome was related to lack of partner treatment during pregnancy (7% versus 19%, odds ratio (OR) 3.0, 95% confidence interval (CI) 0.9- 10.0). Our data suggest that messages focusing on the health of the unborn child have a positive effect on partner notification and innovative and locally adapted strategies for partner notification need more attention.
The efficacy and tolerability of combination antiretroviral therapy in pregnancy: infant and maternal outcome
Authors: Clarke S M , Mulcahy F , Healy C M , Condon S , Butler K M
Published: October 2002

Antiretroviral therapy (ART) and Caesarean section (CS) delivery significantly reduce the risk of vertically transmitted HIV infection. Attention must focus on determining the optimal management strategy for HIV-positive pregnancies. Guidelines must reflect not only the activity and tolerability of combination ART in pregnancy for mother and infant and the potential short and long-term infant toxicity, but also whether surgical delivery can confer an added benefit if combination ART had reduced plasma viraemia to undetectable levels. To aid the development of management strategies for the Republic of Ireland, a retrospective detailed review of all HIV-positive pregnancies since the introduction of combination ART was undertaken. Since 1997 there have been 25 deliveries to 24 women. Combination ART reduced plasma viraemia to undetectable levels in 76% mothers at delivery. The CS rate was 28% and no unanticipated infant toxicity was encountered. To date no infant has proven infected. Three infants have seroreverted and 24 of 26 infants have had at least 2 negative HIV ribonucleic acid (RNA) and polymerase chain reaction (PCR) tests. Two infants are less than one month old. In this study, the CS rate of 28% is below that reported from many centres yet no vertical transmission was found. Given the efficacy of ART in reducing plasma viraemia, the additional benefit of CS for these women is questionable.
The association of Mycoplasma hominis, Ureaplasma urealyticum and Mycoplasma genitalium with bacterial vaginosis: observations on heterosexual women and their male partners
Authors: Keane E A , Thomas J , Gilroy B , Renton A , Taylor-Robinson D
Published: October 2002

Summary: The prevalence of 3 mycoplasmas (Mycoplasma hominis , Ureaplasma urealyticum and Mycoplasma genitalium) was determined in a cohort of women with or without bacterial vaginosis (BV) and in their respective male partners. Heterosexual women with or without BV and their male partners were recruited and genital sampling for these microorganisms was performed. Seventeen women with BV and 21 women with normal flora, and their respective male partners, were recruited. M. hominis was present in 9 (53%) of 17 women with BV compared with none of 21 women without BV (P =0.0001). Of the 17 male partners of women with BV, 8 (47%) had M. hominis compared to 5 (24%) of 21 male partners of women without BV (not significant [n/s]). U. urealyticum was detected in 11 (65%) of 17 women with BV in comparison with 10 (48%) of 21 women without BV (n/s). U. urealyticum was present in 4 (24%) of 17 male partners of women with BV compared to 6 (29%) of 21 male partners of women without BV (n/s). M. genitalium was not detected in any of 15 women with BV and in only 2 (12%) of 17 women without BV (n/s). M. genitalium was present in 4 (25%) male partners of 16 women with BV in comparison with 3 (16%) male partners of 19 women without BV (n/s). Thus, M. hominis was the only mycoplasma detected significantly more often in women with, rather than in those without, BV. None of the mycoplasmas was found significantly more often in male partners of women with, rather than those without, BV. Overall, M. genitalium behaved somewhat similar to Chlamydia trachomatis . It was the least commonly occurring mycoplasma, a reflection perhaps of the relatively low incidence of partner change in this study population.
The reasoning behind decisions not to take up antiretroviral therapy in Australians infected with HIV
Authors: Gold R S , Hinchy J , Batrouney C G
Published: October 2002

A substantial minority of HIV-infected Australians are not taking antiretroviral drugs. This study investigated the reasons behind their decision not to do so. Anyone who was HIV-infected but not taking antiretroviral drugs could participate. A self-administered, anonymous questionnaire was used, the principal recruitment method being through insertion of the questionnaire into gay community newspapers in Sydney and Melbourne. All respondents were asked questions covering demographics, previous AIDS-defining illnesses, T-cell and viral load monitoring, and previous use of antiretroviral drugs. In addition, respondents who had considered going on antiretroviral treatment, but then decided not to do so, were given a list of possible reasons for their decision and asked to indicate how much each played a role in their thinking. Of the 270 respondents, the great majority were gay men. One-eighth had experienced AIDS-defining illnesses. Two-thirds had recently had T-cell and viral load tests. One-third had taken antiretroviral drugs previously. Over two-thirds had considered antiretroviral therapy, most having given the matter quite some thought. Reasons for not taking up therapy did not differ greatly at different stages of HIV disease. The most common individual reason was fear of side effects. Important themes that emerged from factor analysis of the reasons data included distrust of conventional medical approaches to treatment, practical problems associated with taking antiretroviral drugs, unpleasant thoughts that being on therapy would evoke, and acceptance of the idea of dying. The findings can be used by doctors and counsellors to help patients clarify and evaluate their concerns about antiretroviral therapy.
Gay men in Australia who do not have HIV test results
Authors: Van de Ven Paul , Prestage Garrett , Knox Stephanie , Kippax Susan
Published: October 2002

Whereas most gay men in Australia know their HIV test result, a consistent minority do not. From Gay Community Periodic Surveys (n = 6831) conducted during 1998 in the 5 largest cities, those who did not have HIV test results (13.3% overall) comprised 10.0% in Sydney, 15.7% in Melbourne, 13.6% in Brisbane, 15.2% in Perth and 14.0% in Adelaide, representing a significant difference between cities (P < 0.001). Gay men who did not have HIV test results differed from those who did in several ways. They were on average younger (31 vs 35 years, P < 0.001) and less likely to be in professional occupations (P < 0.001). They were less likely to identify themselves as 'gay' (P < 0.001), spent less time with other gay men (P < 0.001) and had fewer gay friends (P < 0.001). They had sex with fewer different men 'in the previous 6 months' (P < 0.001) and were more likely to be in a monogamous relationship or without sexual partners at the time of the survey (P < 0.001). With respect to both regular and casual partners, they were more likely (P < 0.001) to have 'no such partner'/'no anal intercourse' rather than 'anal intercourse' (either always protected or sometimes unprotected). These differences between gay men who did and did not have HIV test results were confirmed in a logistic regression (apart from 'amount of free time spent with gay men' and 'relationship status' which were accounted for by closely correlated variables in the reduced logistic model). Social and sexual environment appears to exert an influence on HIV testing rather than sexual risk per se.
Vaginal infections in pregnant women in Jamaica: prevalence and risk factors
Authors: Kamara Paul , Hylton-Kong Tina , Brathwaite Alfred , Rosario Gelen R Del , Kristensen Sibylle , Patrick Nancy , Weiss Heidi , Figueroa Peter J , Vermund Sten H , Jolly Pauline E
Published: October 2002

Trichomoniasis, bacterial vaginosis (BV) and candidiasis are reproductive tract infections (RTIs) of the vagina. We conducted a cross-sectional study in 4 prenatal clinics in Kingston, Jamaica, to estimate the prevalence of these infections and the risk factors that may facilitate their transmission among pregnant women. Of the 269 women studied, 18.0% had culture-positive trichomoniasis, 44.1% had BV (Nugent score 7) and 30.7% were positive for candidiasis by wet mount. A multiple logistic regression analysis showed that having a malodorous discharge was associated with trichomoniasis (odd ratios [OR]=3.9, confidence intervals [CI]=1.04-14.7) and BV (OR=3.4, CI=1.3-8.7). Women who took action to prevent HIV infection had lower BV prevalence (OR=0.34, CI=0.12-0.98). Women who were employed were less likely to have any of the infections (OR=0.61, CI=0.36-1.03). The strong association of a symptomatic presentation with trichomoniasis and BV suggests the merit of considering syndromic management of vaginitis in this population.
The stability between two HIV-1 RNA measurements one year apart and the relationship with HIV subtype in rural Uganda
Authors: Morgan Dilys , Kaleebu Pontiano , Whitworth Jimmy , Yirrell David , Rutebemberwa Alleluiah , Shier Rosie , Sebabi Baleke , Gilmour Jill , Eotu Henry , Omoding Nicholas , Gotch Frances
Published: October 2002

We compared HIV-1 RNA levels using the nucleic acid sequenced based amplification (NASBA) test kit in 2 samples taken one year apart from participants infected with env subtype A or D in a population-based cohort in Uganda. Fifty participants were infected with subtype A and 70 with subtype D. HIV-1 RNA levels were significantly higher in subtype D unadjusted ( P = 0.001), and after adjusting for age, gender, and CD4 count ( P < 0.001). Eighty-six participants had HIV-1 RNA measurements in both years and 67 (78%) were within one log10 of their result a year before. There was no relationship between the difference in log viral load and proportion of CD4 change. Individuals infected with subtype D had a higher average increase in viral load and this was statistically significant if adjusted for baseline levels and CD4 count ( P = 0.015).
Treatment-related empowerment: preliminary evaluation of a new measure in patients with advanced HIV disease
Authors: Webb D. G. , Horne R. , Pinching A. J.
Published: October 2002

This paper presents a novel method for assessing patients' perceptions of empowerment in the context of drug therapy, the Treatment-related Empowerment Scale (TES). The 10-item TES was specifically constructed to address components of communication, treatment choice, decision-making and satisfaction. Evaluation of the scale in a cross-sectional anonymous survey of 43 patients with advanced HIV infection revealed acceptable internal reliability (Cronbach's alpha=0.85) and evidence of both criterion and discriminant validity. Patients who perceived a high degree of treatment-related empowerment were less likely to view doctors as overly reliant on prescribing medicines and reported lower rates of intentional non-compliance. The TES has scope as a concise measure of patients' degree of control over the selection and use of drug therapy, and may be of particular value for current combination therapy regimens.
Cervical smears: comparison of knowledge and practice of a general practice sample with a high-risk group
Authors: ní Riain A. , Stewart M. , Phelan D. , Bury G. , Mulcahy F.
Published: October 2002

Successful cervical screening programmes depend on the participation of an informed target population. A national cervical screening programme is shortly to be introduced in the Republic of Ireland. We compare the knowledge, attitudes and practice of 395 Irish urban women with 323 high-risk women, genitourinary medicine (GUM) clinic attenders. There was little difference in knowledge between the 2 groups. Fifty-five per cent of the general practice (GP) sample and 45% of the GUM sample correctly identified the purpose of a smear. Eighty-three per cent of both groups had had at least one smear but only 59% of the high-risk group had had a smear before attending the GUM clinic. Both groups expressed a preference for a female provider. Socio-economic grouping is the strongest predictor of knowledge and uptake of cervical smears and high-risk women were less likely to have opportunistic cervical smears. Information programmes to encourage participation in screening programmes must build on pre-existing knowledge and focus on the relevance and acceptability of the test.
Effect of adverse storage conditions of antigen reagent on performance of the rapid plasma reagin test
Authors: van Dyck E , de Deken B , Laga M
Published: October 2002

The aim of this study was to evaluate the performance of rapid plasma reagin (RPR) testing using expired and adversely stored antigen reagent. The sensitivity of RPR using antigen stored at 36°C was compared at 3-monthly intervals with RPR using fresh antigen on 116 sera reactive by RPR and by Treponema pallidum particle agglutination (TPPA). After multiple phases of freezing and thawing, 8.3% of initial RPR reactive sera seroreverted. After storage at 36°C for one year and 24 weeks after expiration the overall sensitivity of the adversely stored antigen was 93.8% compared with fresh antigen; the sensitivity was 100% for sera with RPR titres ≥ 1:4 and 85.4% for sera with RPR titres of 1:1 and 1:2. The high stability of the reagent may increase the feasibility of the RPR test for use in poorly-equipped healthcare centres in developing countries.
Re-audit of antiretroviral prescribing in HIV patients
Authors: Hextall Rachel , Monteiro Eric F.
Published: October 2002

We have found an overall improvement in the prescribing of antiretroviral therapy (ART) in the Yorkshire region between 1997 and 1999 but have identified a clinic where a significant number of patients continue on suboptimal treatment. It has been shown that the substantial reduction in the HIV-associated morbidity and mortality was related to the introduction of protease inhibitors (PIs), which became part of triple ART regimens in mid 1990s. There is evidence that treatment with 2 agents will eventually fail and such prescribing needs to be addressed. Further investigation has shown that patient choice has been an important issue in this locality. Treatment options need to be negotiated between patient and physician and prescribing contrary to patients' wishes may adversely affect adherence. The British HIV Association (BHIVA) guidelines were updated earlier this year to reflect recent advances in management. In view of the importance of optimal prescribing, ART is kept as a standing item on the agenda at our regional audit meetings. These are held every 4 months. We will continue to audit this topic at regular intervals.
Mycobacterium xenopi osteomyelitis in a patient on highly active antiretroviral therapy (HAART)
Authors: Kulasegaram R. , Richardson D. , Macrae B. , de Ruiter A.
Published: October 2002

Skeletal infections with atypical mycobacteria are a manifestation of advanced HIV disease, most patients having CD4 counts of less than 100 cells/mm3. We report a case of Mycobacterium xenopi vertebral osteomyelitis in a patient on HAART with a CD4 count of 490 cells/mm3 and viral load below the level of detection at the time of diagnosis.
Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients
Authors: Carey M. P. , Carey K. B. , Maisto S. A. , Gordon C. M. , Weinhardt L. S.
Published: October 2002

This paper describes a series of 4 studies, designed to provide evidence of the feasibility, reliability, and validity of the Timeline Followback (TLFB) method when used to assess sexual risk behaviour with psychiatric outpatients. This population was selected because patients often have difficulty completing assessments of sexual risk behaviours due to deficits in attention, memory, and communication skills. All 4 studies demonstrated the feasibility of the HIV-risk TLFB. Study 1 also demonstrated that it can be completed in 20 min, and scored in less than 10 min. Qualitative data revealed that both patients and assessors found the features of the TLFB helpful. Study 2 provided evidence that the HIV-risk TLFB can be reliably scored by interviewers whereas Study 3 demonstrated that this measure can be completed reliably by patients and that TLFB of sexual behaviour were consistent over time. Study 4 provided initial evidence for the validity of the HIV-risk TLFB but also suggested that the TLFB may yield frequency estimates that are slightly less than those obtained with single-item measures. We conclude that the TLFB is feasible, reliable, and valid, even in a population known to have difficulty with self-report measures.
Condom use during a community intervention trial in Kenya
Authors: Welsh M J , Feldblum P J , Kuyoh M A , Mwarogo P , Kungu D
Published: October 2002

We conducted a cluster-randomized community intervention trial at Kenyan agricultural sites to measure the impact of female condom introduction on sexually transmitted infection (STI) prevalence. We present male and female condom use data here. Six Intervention sites received a community risk-reduction campaign and distribution of female condoms and male condoms, while 6 Control sites received the same campaign with male condoms only. Male and female condom distribution increased throughout follow-up. Self-reported male condom use increased substantially during follow-up to over 60% of the participants. The proportion of consistent male condom users at Control sites was higher than at Intervention sites, 23% vs 14% at 6 months and 24% vs 22% at 12 months. At Intervention sites, 11% and 7% of women used the female condoms all the time at 6 and 12 months, respectively, while the percentage of female condom non-users grew. Male and female condom use was hindered by male partner objections; suspicion of the study and the devices among residents; and bias against condoms by clinic service providers. A large proportion of coital acts remained unprotected during the trial. Our female condom intervention did not reduce STI prevalence, compared with male condom promotion only.
The risk of myocardial infarction in HIV-infected patients receiving HAART: a case report
Authors: Muise Aleixo , Arbess Gordon
Published: October 2002

With the advent of highly active antiretroviral therapy (HAART), HIV-related morbidity and mortality has declined. Patients are surviving longer but with serious side effects, especially those receiving protease inhibitors (PIs). We report a case of a healthy young man receiving triple therapy with typical angina symptoms that were not recognized by physicians.