bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of functional outcomes (speech, swallowing and voice) in patients attending speech pathology after head and neck cancer treatment(s): development of a multi-centre database
Authors: Perry Alison R. , Shaw Margaret A.
Published: October 2002

Since April 1997, in Melbourne, Australia, speech pathologists have collaborated to establish a prospective database of functional outcomes of speech, swallowing and voice for patients undergoing head and neck cancer treatments.

Staff at eight acute care hospitals, all of which offer speech pathology for head and neck cancer services in Victoria, are contributing data, collated centrally, in an agreed pro forma.

Early results are given (after 12 months’ data collection). The implications for clinically-based research, and the future potential for benchmarking outcomes – by expansion of the rehabilitation database beyond the current participating sites – is discussed.

This paper outlines the rationale of establishing the database is multicentred, and explores some of the complexities involved, including the challenges inherent in long-term accurate data collection in the head and neck cancer patient population. This work represents the development of an appropriate, usable tool for data collection on functional outcomes.
Self-retaining aural speculum: a valuable aid to middle-ear surgery
Authors: Gana P. N. , Reddy T. N.
Published: October 2002

We report the use of a self-retaining aural speculum that provides an excellent view of the middle ear through a small endural incision. We have found this instrument of value in tympanoplasty and stapes surgery in particular.
Acute epiglottitis: a review of 80 patients
Authors: Nakamura Hidei , Tanaka Hidekazu , Matsuda Akifumi , Fukushima Erika , Hasegawa Makoto
Published: October 2002

We reviewed 80 patients admitted to our hospital who were diagnosed with acute epiglottitis between January 1995 and March 1999, and their clinical features, evolution and treatments were analysed. No sexual predominance was found, and there was no patient younger than 16 years of age. The patient fatality rate was 1.3 per cent, and the hospitalization period was markedly longer than those of other reports.
Osteolipoma of the skull base
Authors: Hazarika P. , Pujary Kailesh , Kundaje Harish G. , Rao P. Lakshmi
Published: October 2002

Although lipomas are the most common benign tumours of the head and neck, the involvement of the skull base is rare and it is also very rare for a lipoma to undergo osseous metaplasia to become an ossifying lipoma or osteolipoma. We present a case of a solitary osteolipoma involving the skull base in a 17-year-old girl. A few cases of osteolipoma involving the head and neck have been reported, but this may be the first reported case of a solitary osteolipoma involving the skull base with extension to the infratemporal fossa and parapharyngeal space. The computed tomography (CT) scan helped to clinch the diagnosis and the histopathology confirmed it. The clinical presentation, role of CT scan, surgical approach used, histological features and the review of literature are discussed.
Spontaneous temporal encephaloceles masked by dual pathology: report of two cases
Authors: Paleri Vinidh , Watson Carl
Published: October 2002

Spontaneous temporal meningoencephaloceles are rare entities and diagnostic difficulties can occur. We present two cases whose presentation was atypical and diagnosis delayed by the presence of dual pathology.
Cervical osteophytes presenting as unilateral vocal fold paralysis and dysphagia
Authors: Yoskovitch Adi , Kantor Stephen
Published: October 2002

Any process involving either the vagus nerve, its recurrent laryngeal branch or the external branch of the superior laryngeal nerve may cause paralysis of the vocal fold. The most common cause is neoplasm. Clinically, the patients often present with a hoarse, breathy voice as well as symptoms of aspiration. The following represents a unique case of unilateral vocal fold paralysis and dysphagia caused by a degenerative disease of the cervical spine, resluting in extrinsic compression of the recurrent laryngeal nerve.
Outcome of 22 cases of perforated tympanic membrane caused by otomycosis
Authors: Hurst William B.
Published: October 2002

Twenty-two cases of perforated tympanic membrane due to fungal otitis externa were observed over a five-year period.

The diagnosis of fungal otitis externa was made on clinical grounds due to the obvious presence of fungal bloom in the external ear canal. Some perforations were noted at the first treatment after the fungal debris had been removed from the external ear canal using a microscope. Other perforations were observed to develop over a few days. Initially, a discrete area of the tympanic membrane appeared white and opaque. As time progressed the white area disintegrated, forming a perforation. Once the otitis externa had resolved most perforations healed spontaneously. Two that were observed to develop during treatment required a myringoplasty. Another one closed significantly but a tiny persistent perforation required cauterization with trichloracetic acid to encourage it to close over completely. The only residual hearing loss was in a case with almost total disintegration of the tympanic membrane requiring a myringoplasty.

Treatment of fungal otitis externa for the patients in this series was aural toilet using suction under a microscope and insertion of a gauze wick saturated in a combination of hydrocortisone, clotrimazole, framycetin and gramicidin.
Expression of telomerase activity in cholesteatoma otitis media
Authors: Goh Eui-Kyung , Lee Byung-Joo , Wang Soo-Geun , Chon Kyong-Myong , Kim Chul-Min
Published: October 2002

Telomerase maintains the length of telomeres in immortal cells and is also often associated with cell proliferation. Cholesteatoma epithelium is characterized by a dysregulation with hyperproliferative growth. The study evaluated the telomerase activity in cholesteatoma and normal retro-auricular skin to discover the relationship between telomerase expression and clinical findings. Twenty-two samples of cholesteatoma and 15 samples of retro-auricular skin were obtained from patients undergoing middle-ear surgery. The telomerase activity was detected by the telomerase repeat amplification protocol (TRAP) assay method. Seventeen of the 22 (77.3 per cent) cholesteatoma cases expressed telomerase activity, whereas none of the 15 retro-auricular normal skin (0 per cent) detected telomerase activity. There was no significant difference between telomerase expressions and clinical findings, including hearing level, duration of disease, and the degree of extension (p>0.05). The high expression of telomerase in cholesteatoma suggests that the activation of telomerase may be related to the proliferative nature of cholesteatoma.
Lemierre’s syndrome as a consequence of acute supraglottitis
Authors: Hope Andrew , Bleach Nigel , Ghiacy Sabour
Published: October 2002

Lemierre’s syndrome comprises internal jugular vein thrombosis following oropharyngeal sepsis and is a rare and serious condition. It is most commonly caused by the anaerobe Fusobacterium necrophorum and typically presents as metastatic sepsis to the lungs and joints. Thrombosis is demonstrated by computed tomography (CT) of the neck, and it is routinely treated with intravenous antibiotics and anti-coagulation.

We describe a case of Lemierre’s syndrome following acute supraglottitis. The clinical features were of retrograde intracranial thrombosis, rather than the more usual metastatic sepsis.
Parotid gland surgery: a retrospective review of 108 cases
Authors: Harney M. , Walsh P. , Conlon B. , Hone S. , Timon C.
Published: October 2002

One hundred and eight parotidectomies performed by a single consultant were reviewed. Eighty-five patients had primary parotid disease, 23 patients had extra-parotid primaries. Pleomorphic adenoma was the most common histological diagnosis. In patients with primary parotid disease, a post-operative temporary facial nerve palsy was noted in 15 patients, with a further four developing a permanent palsy. Patients with metastatic disease to the parotid had a poor prognosis.
A case of myoepithelioma arising in an accessory parotid gland
Authors: Kawashima Yoshiyuki , Kobayashi Daisuke , Ishikawa Norihiko , Kishimoto Seiji
Published: October 2002

The present paper describes the first reported case, to our knowledge, of a myoepithelioma arising in an accessory parotid gland. Because pre-operative fine-needle aspiration cytological findings and operative findings suggested that this tumour was malignant, the decision was made to remove the tumour surgically along with the buccal branches of the facial nerve. The resected nerve was reconstructed by nerve transplantation, using the great auricular nerve. Subsequently the tumour was found to be benign. One year after surgery, the patient had excellent facial nerve function and so far there has been no evidence of recurrence.
The anti-oxidant and anti-apoptotic activities of selenium in the prevention of myringosclerosis in rats
Authors: Görür Kemal , Özcan Cengiz , Polat Ayse , Ünal Murat , Tamer Lülüfer , Cinel İsmail
Published: October 2002

The possible effect of selenium on the prevention or reduction in occurrence of myringosclerosis was investigated. Fifteen rats were myringotomized bilaterally and separated into two groups. Nine rats were treated with selenium in the study group. Six rats were administered physiological serum and formed the control group. The occurrence of myringosclerotic lesions and anti-apoptotic activity in the tympanic membranes of the two groups were compared otomicroscopically and histopathologically. The sclerosis was occasional in three, moderate in five and severe in three tympanic membranes in the control group. On the other hand sclerosis was observed in only two of 18 specimens in the study group and sclerosis was seen only occasionally in these two sections. Although Bcl-2 staining, which indicates apoptosis, was not statistically different between the groups, it was observed that apoptosis was slightly more apparent in the study group (eight of 18 tympanic membranes versus two of 12 tympanic membranes in the control group). In conclusion, the formation of myringosclerosis following myringotomy in rats can be reduced by intraperitoneal selenium administration.
An intra-individual comparison of the previous conventional hearing aid with the bone-anchored hearing aid: the Nijmegen group questionnaire
Authors: McDermott Ann-Louise , Dutt Sunil N. , Reid Andrew P. , Proops David W.
Published: October 2002

By spring 2000, a total of 351 patients were implanted in the Birmingham bone-anchored hearing aid (BAHA) programme. This group consisted of 242 adults and 109 children. The aim of this retrospective questionnaire study was to directly assess patient satisfaction with their current bone-anchored hearing aid in comparison with their previous conventional air and/or bone-conduction hearing aids.

The Nijmegen group questionnaire was sent by post to 312 patients who used their BAHA for six months or longer. The questionnaire used was first described by Mylanus et al. (Nijmegen group) in 1998. The total response rate was 72 per cent (227 of 312 patients). The bone-anchored hearing aid was found to be significantly superior to prior conventional hearing aids in all respects.
Speech intelligibility with bilateral bone-anchored hearing aids: the Birmingham experience
Authors: Dutt Sunil N. , McDermott Ann-Louise , Burrell Stuart P. , Cooper Huw R. , Reid Andrew P. , Proops David W.
Published: October 2002

The Birmingham bone-anchored hearing aid (BAHA) programme, since its inception in 1988, has fitted more than 300 patients with unilateral bone-anchored hearing aids. Recently, some of the patients who benefited extremely well with unilateral aids applied for bilateral amplification. To date, 15 patients have been fitted with bilateral BAHAs. The benefits of bilateral amplification have been compared to unilateral amplification in 11 of these patients who have used their second BAHA for 12 months or longer. Following a subjective analysis in the form of comprehensive questionnaires, objective testing was undertaken to assess specific issues such as ‘speech recognition in quiet’, ‘speech recognition in noise’ and a modified ‘speech-in-simulated-party-noise’ (Plomp) test.

‘Speech in quiet’ testing revealed a 100 per cent score with both unilateral and bilateral BAHAs. With ‘speech in noise’ all 11 patients scored marginally better with bilateral aids compared to best unilateral responses. The modified Plomp test demonstrated that bilateral BAHAs provided maximum flexibility when the origin of noise cannot be controlled as in day-to-day situations. In this small case series the results are positive and are comparable to the experience of the Nijmegen BAHA group.
Paediatric tracheostomy: Sheffield Experience 1979–1999
Authors: Midwinter Katie I. , Carrie Sean , Bull Peter D.
Published: October 2002

We have reviewed our experience of tracheostomy in children over the past 20 years at Sheffield Children’s Hospital. One hundred and forty-eight tracheostomies were performed in 143 children aged one day to 13 years old (average 27 months). Sixty-five per cent of patients were <one year old. The indications for tracheostomy were upper airways’ obstruction in 72 per cent, and assisted ventilation/bronchopulmonary toilet in 28 per cent. The commonest single reason was acquired subglottic stenosis (SGS) in infants, accounting for 25 per cent of tracheostomies (36/143). The complication rate of tracheostomy was 46 per cent, most commonly granulation tissue formation. There were four deaths directly due to the tracheostomy: two accidental decannulations and two obstructions. Eighty-nine children were decannulated under our care. The average time until decannulation was 25 months.
Penetrating injury of the cheek requiring skull base exploration
Authors: Patel N. N. , Wang S. C. , Marentette L.
Published: October 2002

We report a case of a very unusual penetrating injury of the middle third of the face. The patient was involved in a road traffic accident, and the indicator control lever became impaled in his right cheek. There was contralateral orbital damage resulting in loss of sight. The cribriform plate was breached and a pneumoencephalocele ensued.

We discuss the modern management of such injuries including injury assessment. We emphasize the importance of crash scene information gathering and analysis of injury mechanisms. Facial injury zonal classification and imaging are reviewed in the context of the case. We discuss the reasons that led us to treat this patient via the subcranial approach.
Schwannomatosis in a child – or early neurofibromatosis type 2
Authors: Shaida A. M. , O’Donovan D. G. , Moffat D. A.
Published: October 2002

A case of multiple cervical schwannomas in a five-year-old boy, without other evidence of neurofibromatosis type 2, is described. Schwannomatosis is a disorder characterized by the presence of multiple schwannomas in the absence of neurofibromatosis type 2 that has only been recognized in the last 15 years. The clinical and genetic features of neurofibromatosis types 1 and 2 and schwannomatosis are compared and contrasted. This patient with possible schwannomatosis is presented to illustrate the potential pitfalls of making this diagnosis in the paediatric age group and to increase awareness of the debate on whether this is a distinct entity or a form fruste of neurofibromatosis type 2.
Blood catalase and haematocrit values in a breeding colony of Dutch-belted rabbits
Authors: Foote R. H. , Hare E.
Published: October 2002

Rabbit seminal plasma catalase is much higher than in the semen of other mammals, and differences appear to be inherited. Because of the scarcity of information on rabbit blood catalase and haematocrit in Dutch-belted rabbits, an investigation of possible effects of gender, age and genetics on these variables was undertaken. There were 191 rabbits sampled at 2-3 months, 130 at 12 months and 61 at 18-24 months of age. There was no age effect on the haematocrit values and on blood catalase activity. At 12 months of age males had an average haematocrit value of 44% compared with 40% for females ( P < 0.05). Corresponding average catalase values were 431 and 356 units/ml of blood ( P < 0.05). Also catalase was measured in the semen and blood of 34 males, and males differed in both their blood and semen catalase activity ( P < 0.05). The correlation between the two traits was r = 0.44. Heritability ( h2) estimates, based on 231 rabbits were 0.40 for blood catalase activity, and 0.26 for haematocrit. The genetic correlation between the two variables was 0.83 ( P < 0.05). These studies are consistent with the literature in that female rabbits have a slightly lower haematocrit value than males, and this is associated with a lower catalase activity. This appears to be the first report of a study that compares rabbit blood catalase in males and females of different ages. Preliminary evidence that differences may have a heritable basis is consistent with previous studies on rabbit semen catalase.
Implantable device for intravenous drug delivery in the rat
Authors: de Wit Maike , Raabe Annette , Tuinmann Gert , Hossfeld Dieter Kurt
Published: October 2002

The experimental design of studies using small laboratory animals may require repeated venous access for the application of drugs or diagnostics. An appropriate device should provide quick intravenous access without causing severe handling stress to the animals or the necessity of anaesthesia. In addition, the system should be suitable for repeated injections over several weeks. A silicone catheter is connected to an intravenous indwelling cannula with fixation wings. A closure stopper with injection port completes this system. The device is fixed subcutaneously on the back of the animal and the catheter is inserted into the jugular vein. The device is easily and quickly assembled and is more economic than commercial systems. It is easily implanted and allows repeated intravenous injections for several weeks without anaesthesia or restraint of the animals. The method allows repeated intravenous drug delivery over a couple of weeks in small animals.
Diagnosis of sexual cycle by means of vaginal smear method in the chinchilla (Chinchilla lanigera)
Authors: Bekyürek Tayfur , Liman Narin , Bayram Güner
Published: October 2002

An investigation was made as to whether the sexual cycle and pregnancy can be determined by means of vaginal smear in chinchillas. This study represents the first attempt to record changes which occur in the pattern of exfoliated cells in chinchilla's vaginal smear during anoestrus, proestrus, oestrus, metoestrus and pregnancy. Fifteen female chinchillas aged from 8 months to 3 years and bred through harem breeding method were used. The major change during proestrus was an increase in the proportion of superficial cells, with a corresponding decrease in other cells. Goblet cells were observed in the smears prepared by strong aspiration during this cycle. Neutrophils, small and large intermediates and parabasal cells were not found in the smear during oestrus and the smear consisted of superficial cells only. In the proportion of neutrophils, small and large intermediates and parabasal cells increased during metoestrus. In addition, metoestrum and foam cells were found in this cycle. In anoestrus; superficial and parabasal cells were present in small numbers. Also small and large intermediate cells as well as neutrophils were present. Traces of foam and metoestrum cells were found. During pregnancy, neutrophils generally of medium density were present, parabasal; small and large intermediate cells were present at low or medium density, and superficial cells were only present in trace amounts.
Effects of CO2 anaesthesia on central nervous system activity in swine
Authors: Martoft L. , Lomholt L. , Kolthoff C. , Rodriguez B. E. , Jensen E. W. , Jørgensen P. F. , Pedersen H. D. , Forslid A.
Published: October 2002

The objective of the study was to examine the changes in central nervous system (CNS) activity and physical behaviour during induction and awakening from CO2 anaesthesia. Two studies, each using pigs immersed into 90% CO2 gas for a period of 60 s were performed. In study 1, we monitored middle latency auditory evoked potentials (changes in latencies, amplitudes and a depth of anaesthesia index), electroencephalographic parameters (delta, theta, alpha and beta electroencephalographic power and 95% spectral edge frequency) and heart rate; and in study 2, we monitored body movements and arterial and venous partial pressure of CO2 and O2. No behavioural signs of distress were observed during the early part of the induction. The swine exhibited muscular activity from 13-30 s after induction-start as well as during awakening from anaesthesia, possibly because of a transitory weaker suppression of the brain stem than of the cortex. The CNS and blood gas parameters started to change from the very start of induction. The CNS suppression lasted only approximately one minute after the end of the induction period. The two studies indicated a good temporal relationship between changes in amplitude, depth of anaesthesia index, spectral edge frequency, and arterial PCO2 during the induction period.
Determination of plasma volume in anaesthetized piglets using the carbon monoxide (CO) method
Authors: Heltne J. K. , Farstad M. , Lund T. , Koller M. E. , Matre K. , Rynning S. E. , Husby P.
Published: October 2002

Based on measurements of the circulating red blood cell volume (VRBC) in seven anaesthetized piglets using carbon monoxide (CO) as a label, plasma volume (PV) was calculated for each animal. The increase in carboxyhaemoglobin (COHb) concentration following administration of a known amount of CO into a closed circuit re-breathing system was determined by diode-array spectrophotometry. Simultaneously measured haematocrit (HCT) and haemoglobin (Hb) values were used for PV calculation. The PV values were compared with simultaneously measured PVs determined using the Evans blue technique. Mean values (SD) for PV were 1708.6 (287.3)ml and 1738.7 (412.4)ml with the CO method and the Evans blue technique, respectively. Comparison of PVs determined with the two techniques demonstrated good correlation ( r = 0.995). The mean difference between PV measurements was -29.9 ml and the limits of agreement (mean difference ±2SD) were -289.1 ml and 229.3 ml. In conclusion, the CO method can be applied easily under general anaesthesia and controlled ventilation with a simple administration system. The agreement between the compared methods was satisfactory. Plasma volume determined with the CO method is safe, accurate and has no signs of major side effects.
Rationing hospital services in Hong Kong: priority setting by clinicians using the Delphi method
Authors: Yuen Peter P. , Gould Derek , Cheng M. Y.
Published: October 2002

This article presents the results of a demonstration project of priority setting by clinicians in Hong Kong's public hospitals. Thirty-five chiefs-of-service of public hospitals in Hong Kong participated in a three-round Delphi exercise on identifying interventions that should be charged in public hospitals on the basis of questionable effectiveness and other reasons. A total of 246 interventions were identified in the first round, 126 of which received a positive score (indicating a high degree of consensus amongst the participants) at the end of the final round. The interventions that received higher scores tend to be preventive services, treatment of an elective nature, and procedures for sex-related conditions. As the number of interventions with positive scores in the final round are relatively small, the amount of money to be recovered from charging these interventions is not likely to be substantial. Such results suggest that rationing by itself cannot be a solution to the problems of healthcare financing in Hong Kong.
Reconceptualizing case management in theory and practice: a frontline perspective
Authors: Roberts Deborah Yarmo
Published: October 2002

'Case management' in the health and social service sector is controversial, highly political and saturated with conflicting agendas among stakeholders. Research was conducted recently to explore the role of case managers in three evolving, Australian-based, long-term care, case management models. The findings have relevance to countries worldwide that contend with delivering quality care that is cost effective. The research captures the perspectives of 51 open-ended interviews with front-line case managers who have first-hand knowledge of the models' effect on their clients and on their own roles. Contrary to the rhetoric that case management is client-centred, case management is concluded to be 'system centred' based on a unilateral approach taken by each of the three models. Case managers had a limited ability to attain necessary services for clients. Success was dependent on the range of case managers' skills and experience, relationship with the client, degree of job satisfaction, level of influence in the health and social system and ability to collaborate with relevant professionals. The relationship between the three primary influences (system, model, client) affecting case managers' pursuit of achieving appropriate client services was also reviewed. A reconceptualized multidimensional approach, or 'neo-process-centred' case management, is proposed. The revised approach can be applied to existing and new models and has direct implications for policy makers, management and practitioners aspiring to improve client care within existing constraints.
A review of the literature: interventions to maximize capacity to consent and reduce anxiety of women with learning disabilities preparing for a cervical smear test
Authors: Broughton Sallyanne
Published: October 2002

Due to the complex nature of the cervical screening for women with learning disabilities, this literature review has several different strands. The aim of which is to give a general overview of the literature available about women with learning disabilities and cervical screening. Discussing key issues in relation to uptake, access and risk factors associated with cervical screening. The role of the learning disability nurse in supporting access to cervical screening services within primary care will be explored. The notion that anxiety and a woman's capacity to consent impacts on her accessing cervical screening services and ultimately undergoing a cervical smear test, will be examined. Relaxation techniques with regard to ascertaining which techniques are more effective when used with individuals with a learning disability will also be discussed.
Identification of risk factors in blood donors found to have HIV infection
Authors: Bates C M , Carey P B , Martlew V J , Shepherd A J N
Published: October 2002

To ascertain whether current screening procedures for human immunodeficiency virus (HIV) infected blood can be improved, a study of blood donors found by Mersey and North Wales Blood Centre to be HIV positive was made. In total 22 donors were identified, of which 16 were referred to the Department of Genito-Urinary Medicine (GUM) in Liverpool. Most (9/16) should have been excluded from donating because of recognized risk factors. However, in 7 cases no such identifiable factors were found. Although the risk of transfusion transmitted infection is small, there is an argument for testing donated blood for HIV RNA by nucleic acid technology.
CMV colitis in early HIV infection
Authors: Smith P R , Glynn M , Sheaff M , Aitken C
Published: October 2002

Cytomegalovirus (CMV) colitis is a well recognized complication of advanced HIV disease and is only rarely diagnosed in patients with normal immune function. A case of CMV colitis occurring in early HIV infection is described. Although CMV infection is normally confined to patients with advanced HIV disease, it is possible that a number of contributing factors may have led to clinical disease in this patient. CMV colitis is an important diagnosis to consider in all patients who present with a diarrhoeal illness associated with systemic features, regardless of underlying immunosuppression.
Determinants of unsafe sex in women
Authors: Green John , Fulop Naomi , Kocsis Agnes
Published: October 2002

We aimed to identify determinants of condom usage and unsafe sex in women having sex with a new partner. One hundred women attending either a genitourinary medicine (GUM) clinic or a family planning clinic participated in the study. Respondents were interviewed about last 3 new male partners, from the beginning of the sexual relationship through its development, if any. Data analysis was primarily qualitative, quantitative analysis was conducted where appropriate. Alternative contraceptive use was the most commonly reported determinant of condom usage overall. The most commonly reported determinant of condom use for prophylaxis was the woman's perception of her partner and the risks he presented. Models of risky sexual behaviour have focused on the individual's generalized estimation of risks of acquiring STDs. Existing models are poor predictors of risky sexual behaviour. We propose that it is the perceived risk presented by a particular individual partner, not global risk, which influences behaviour. An individual risk model is put forward.
Utilization of healthcare services by people living with HIV/AIDS in Europe
Authors: Baratta C , Schrooten W , Colebunders R , Garcia F , Caldeira L , Coppieters Y , Dreezen C
Published: October 2002

Our objective was to compare the utilization of healthcare/support services for people with HIV infection in Europe. Between August 1996 and September 1997 self-administered anonymous questionnaires were distributed by reference HIV treatment centres and HIV support organizations. The questionnaire was completed by 1366 people living with HIV/AIDS. A small number of people had received influenza or pneumococcal vaccinations (34% and 19% respectively). Many patients did not receive dental care (48% of participants from the southern countries) and only 72% of the women had a gynaecological examination. More participants from the south reported insufficient access to healthcare/support services, particularly for nursing care (19%), psychological support (33%), nutritional advice (45%), access to support organizations (36%), and legal advice (46%). In conclusion, many people living with HIV/AIDS in Europe do not benefit from certain annual medical procedures proposed by international guidelines and consider themselves to have insufficient access to health/support services.
Detecting cervical infection among family planning clients: difficulties at the primary health-care level in Indonesia
Authors: Iskandar M B , Patten J H , Qomariyah S N , Vickers C , Molyneaux S I
Published: October 2002

In developing and testing an operational model for the integration of reproductive tract infection/sexually transmitted disease (RTI/STD) management into existing family planning (FP) services in Indonesia, this study allowed for assessment of disease prevalence and evaluation of diagnostic methods for detection of endocervicitis caused by chlamydial infection and/or gonorrhoea. Data were collected over 28 weeks in 1997 at 2 FP clinics in the low-income harbour neighbourhood of North Jakarta. Among 486 consenting female FP clients, prevalence of chlamydial infection was 9.3%, gonorrhoea 1.2%, trichomoniasis 4.5% and syphilis 0.8%. Clinically observed abnormal vaginal discharge, cervical inflammation and vaginal lesions/ulcers were all associated with cervical infection ( P < 0.05), but insufficiently sensitive (< 60%). Clinical diagnosis for cervical infection had 48.8% sensitivity, 75.4% specificity, but only 18.3% positive predictive value (PPV). On-site Gram stains for gonorrhoea were 83.3% sensitive and 94.5% specific, but had only 16.1% PPV. Presence of mucopurulent cervicitis was only 39.6% sensitive for cervical STD, with PPV of only 16.3%. Development of an affordable and accurate detection tool for chlamydial infection remains the main obstacle to effective RTI/STD management in this population.
Vaccine characteristics and acceptability of HIV immunization among adolescents
Authors: Zimet G D , Blythe M J , Fortenberry J D
Published: October 2002

HIV immunization programmes will only be effective if sufficient numbers of persons accept the vaccine. Our aims were to evaluate HIV vaccine acceptability among adolescents and to examine how vaccine characteristics influence acceptability. We recruited 661 adolescents from community health clinics in Indianapolis, Indiana, USA to complete either written or computerized questionnaires, both of which assessed HIV vaccine acceptability as a function of efficacy, cost, type of vaccine, mode of delivery, and parental permission for immunization (required or not required). For both the written and computer methods, efficacy had the strongest effect on acceptability, followed by type of vaccine and cost. Low efficacy, high cost, and live-attenuated vaccines were associated with lower acceptability. These findings suggest that as efforts to develop HIV vaccines continue, it will be important, in parallel, to anticipate potential obstacles to vaccine acceptance, including the belief that a less efficacious HIV vaccine is unacceptable.
HIV testing in gay sex clubs
Authors: Woods W J , Sabatino J , Bauer P L , Adler B , Dilley J W , Binson D
Published: October 2002

The purpose of this study was to evaluate a programme of human immunodeficiency virus (HIV) antibody testing at gay sex clubs. Conducting secondary analyses with 2 datasets, we evaluated HIV-testing preferences of patrons at 2 sex clubs and compared their risks to testers at a standard testing clinic. Sex club testers had significantly more partners and were significantly older than their clinic peers. Sixteen per cent of sex club testers reported that they would not test if testing were not available at the sex club. Gay sex clubs offer an opportunity to reach men at high risk for HIV, some who otherwise may not test.
The frequency of mutation in CCR5 gene among Koreans
Authors: Oh Myoung-Don , Kim Sung Soon , Kim Eun Young , Lee Sunhee , Kim Namjoong , Park Keun Yong , Kim Uiseok , Kim Thoma , Kim Taigyu , Choe Kangwon , Lee Joo-Shil
Published: October 2002

To better understand a role of the Delta32 allele of the CCR5 gene in HIV-1 transmission and disease progression, we determined the CCR5 genotypes within several groups of Koreans. Amplification of DNA from each subject was achieved with polymerase chain reaction, using the CCR5 specific primer pair, which flanks the 32 bp deletion. The 1.2 kb coding sequences of CCR5 were examined to see the possible effects of CCR5 polymorphism. All of the 339 healthy, HIV-uninfected individuals had no mutation in the CCR5 gene. All of the 115 HIV-1-infected patients including 11 long-term non-progressors (LTNPs) and 18 discordant spouses were also wild homozygotes. No variation in the 1.2 kb CCR5 coding sequence was found in 5 LTNPs and 5 discordant spouses. In conclusion, the 32 bp deletion mutant is rarely present in Koreans. Our data suggest that factors other than the CCR5 coding sequences may also play a role in the resistance to HIV infection.
Silent oophoritis due to cytomegalovirus in a patient with advanced HIV disease
Authors: Manfredi Roberto , Alampi Giulia , Talò Salvatore , Calza Roberto Manfredi Leonardo , Tadolini Marina , Martinelli Giuseppe Nicola
Published: October 2002

A case of isolated necrotizing cytomegalovirus (CMV) oophoritis disclosed only by necropsy studies in a patient with AIDS, is described. This unusual case report is discussed with a review of the literature dealing with CMV involvement of genital organs in the immunocompromised host, and in patients with HIV infection and AIDS.
Post-exposure prophylaxis following non-occupational exposure to HIV: risks, uncertainties, and ethics
Authors: Mackie N. E. , Coker R. J.
Published: October 2002

Post-exposure prophylaxis (PEP) is the standard of care for occupational exposure to HIV infection although it has not been evaluated following non-occupational exposure. Although the most effective methods for preventing HIV infection remain those that prevent exposure to HIV in the first place, this article discusses the dilemmas surrounding post-exposure therapy following non-occupational exposure.
HIV risks in a homeless population
Authors: Lee Doohee , Ross Michael W , Mizwa Michael , Scott Deborah P
Published: October 2002

Homeless people are one of the most vulnerable with regard to HIV transmission. However, most research on this population has been carried out on samples from health clinics. We surveyed 390 homeless people in Houston at a day shelter with regard to their HIV/AIDS knowledge and risk behaviours. The sample was 76% African-American, 11% Euro-American, with small numbers of Latin-Americans, Native-Americans and Asian-Americans: half were born in Texas, and 92% were male. Data indicated that HIV/AIDS knowledge was higher in those who were at higher behavioural risk, although the direction of causality in these crosssectional data cannot be inferred. African-Americans were at slightly higher risk. Compared with previous clinic samples, this sample was older and a higher number (one-third) slept the last night outside. Eighty per cent had had an HIV test. Condom use was low with both males and females most commonly not reporting using condoms although more than half had had sexual contact in the past month. Multivariate analysis indicated that ethnicity and HIV/AIDS knowledge were independent predictors of risk behaviour. Lifetime risks included one-third who had injected drugs (and shared needles), and nearly 10% had had sex with someone they knew to be HIV seropositive. Lack of future time perspective rather than level of knowledge may be a barrier to reducing HIV risks, and the data are discussed in terms of policy implications and homelessness.
General practitioners' views on the screening for genital Chlamydia trachomatis infection and partner notification
Authors: Joshi U Y , Dixon W
Published: October 2002

A postal survey of general practitioners (GPs) in the East Riding of Yorkshire was undertaken to find out their views about screening for Chlamydia trachomatis infection, the reasons for their inability to screen the high-risk population, facilities available for screening in the primary care setting, treatment regimen and the views about partner notification. Although all GPs had the facilities for chalmydial testing, their views on chlamydial screening differed widely and very few offered opportunistic screening. Most of the GPs would prefer the sexual health clinics (genitourinary medicine [GUM] clinics) to undertake partner notification. Less than half of the GPs surveyed offered the ideal antimicrobial therapy against chlamydial infection, as recommended by the Central Audit Group in Genito-urinary Medicine1. This survey shows the necessity to disseminate proper guidelines for the management of uncomplicated C. trachomatis infection in the community. Sexual health clinics should make adequate provision to deal with additional workload resulting from the increased referrals of partners to the clinics when the opportunistic screening is widely provided by the GPs.
Switch of protease inhibitor-containing HAART in routine clinical practice: a four-year prospective observational study
Authors: Manfredi Roberto , Chiodo Francesco
Published: October 2002

An evaluation was made of the frequency of outcomes, the features, and one-year outcomes of the substitution, carried out because of failure or toxicity, of protease inhibitor (PI)-containing highly active antiretroviral therapy (HAART). Nine hundred and seventy-two HIV-infected patients were prospectively followed up since 1996, with the condition that they had a minimum 80% adherence to prescribed regimens. Four hundred and fifty-two changes occurred in 397 of the 876 evaluable patients (45.3%). Virological and/or immunological failure was of concern in 245 cases (54.2%). Interest in saquinavir had the greatest incidence and earliest occurrence (although the subsequent switch had a significantly better outcome than that of patients failing with other PIs); nelfinavir benefited from a shorter time to change and a worse long-term outcome (probably attributable to its predominant use in indinavir- and ritonavir-experienced patients); while indinavir showed the lowest overall frequency of substitution. Intolerance occurred in the remaining 207 cases (45.8%); with saquinavir being better tolerated than other PIs. A favourable outcome was obtained more frequently when poor tolerability was of concern, compared with therapeutic failure ( P <0.008), while no significant differences were found according to prior antiretroviral experience and the subsequently selected HAART regimen. The overall one-year outcome per single substituted compound proved significantly better for patients who stopped using saquinavir and ritonavir, by contrast with those who stopped using indinavir and nelfinavir ( P < 0.0008). A significantly shorter mean time to substitution was recognized for nelfinavir and saquinavir than with ritonavir and indinavir ( P < 0.0001). When analysing the subset of patients experiencing HAART failure, a highly significant reverse relationship was demonstrated between mean time to failure, and rate of subsequent response to a modified antiretroviral regimen ( P < 0.0001). When considering the different patterns of efficacy, durability, resistance induction, expected adherence, and safety of each antiretroviral drug, initial and subsequent therapeutic choices should be carefully balanced against expected benefits and risks.
Lung cancer in HIV-infected patients: a one-year experience
Authors: Ricaurte J. C. , Hoerman M. F. , Nord J. A. , Tietjen P. A.
Published: October 2002

The relative incidence and rate of lung cancer in HIV-infected patients compared with the general US population has been a source of controversy. We sought to establish these parameters in a cohort of 2616 HIV-infected patients. Tumour type, stage of disease, patient demographics and immune parameters including viral loads were ascertained. An annual rate of 191 cases/100,000 population was found, which is 3.01 times greater (95% confidence interval [CI]=1.3-7.0) when compared with the general US population and 7.4 times the rate in US males between ages 35 and 54 (95% CI=3.1-17.8). Three patients had CD4 counts greater than 200 cells/mm3 at diagnosis and 2 had undetectable viral loads. The mean age was 44 years and all had advanced disease and short survival. In conclusion, the incidence of primary lung cancer was increased in this cohort of HIV-infected patients and occurred over a wide range of immunosuppression and viral replication.
Predicting perinatal HIV infection in young Brazilian infants: how accurate are signs, symptoms and immunological abnormalities?
Authors: Mussi-Pinhata M. M. , Cervi M. C. , Isaac M. L.
Published: October 2002

Early identification of infants perinatally infected with HIV (HIV+) requires costly laboratory tests which are not widely available in countries with limited resources. We evaluated the utility of detection of non-specific HIV-related signs and symptoms and immunological abnormalities in the diagnosis of perinatal HIV infection in Brazilian infants younger than 10 months of age and followed from birth. A total of 27 HIV+ and 43 uninfected infants were studied. All infants exhibited one or more non-specific HIV-related findings at least once. HIV+ infants were more frequently symptomatic than HIV- infants only when older than 3 months. Combinations of clinical and immunological findings resulted in high sensitivity (85-100%) and low specificity (25-65%) rates for the diagnosis of HIV infection. Conversely, low CD4+ cell counts and hyperimmunoglobulinaemia showed low sensitivity (52%) and high specificity (100%) rates. In conclusion, the detection of similar findings in HIV- and HIV+ infants underscores the need of early confirmatory laboratory testing.
HIV seroprevalence among military blood donors in Manica Province, Mozambique
Authors: Newman Lori Marie , Miguel Felicidade , Jemusse Bente Belo , Macome Agosto Cesar , Newman Robert David
Published: October 2002

HIV seroprevalence data show an alarming HIV situation in central Mozambique, but little is known about the situation of HIV in Mozambican military personnel. This study is a retrospective analysis of laboratory records for voluntary blood donors at a rural hospital from January 1997 through December 1999. The hospital screened blood samples with HIV SPOT rapid test for HIV and rapid plasma reagin (RPR) serological test for syphilis. Of the 797 blood donors during this period, 110 (13.8%) were military personnel of whom 39.1% were HIV positive (35.0% in 1997, 33.3% in 1998 and 48.7% in 1999). Among the 687 nonmilitary donors 15.3% were HIV positive ( P<0.0001 vs military). 74.4% of HIV-positive military personnel were also RPR positive. Conversely, only 3.0% of HIV-negative military donors were RPR positive. In light of the high rates of HIV and syphilis in military personnel, aggressive intervention measures must be taken to prevent and treat HIV and STDs in this population.
Can we predict who will return to a genitourinary clinic?
Authors: Pitts M K , Cannon S , Johnson I , Singh G , Clarke T , Rahman Q
Published: October 2002

One hundred and eighty-eight first-time attenders at a genitourinary (GU) clinic were monitored to establish who returned following discharge after treatment. Thirty-six (19%) returned within 2 years with a new infection. The re-attenders did not differ significantly from the rest of the cohort by age, gender or occupation, nor did they differ in their sexual history and psychological variables. Re-attenders were significantly more likely to have consulted their general practitioner (GP) in the 6 months prior to their first clinic attendance.
Triage clinics: a way forward in genitourinary medicine
Authors: Harindra V , Tobin J M , Tucker L J
Published: October 2002

Our objective was to evaluate the effectiveness of a nurse-led triage clinic in genitourinary medicine (GUM). A prospective study was made of 200 consecutive patients attending the triage clinic in the GUM Department, Portsmouth. These patients were seen by the triage nurse and treated according to clinic guidelines. The consultants reviewed the case notes to assess the appropriateness of management. During the 6-week study period, 3009 patients were seen in the department. Of the 200 patients seen in the triage clinic, 38 were referred to a doctor during the initial visit. One or more sexually transmitted or associated infections were found in 61 female and 58 male patients. Six female and 4 male patients were not treated according to the clinic guidelines. Given appropriate education and training and working within a supportive framework the nurse undertaking a triage role in GUM can provide a highly effective and high-quality service to patients.