bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence of thymic reconstitution after highly active antiretroviral therapy in HIV‐1 infection
Authors: Hardy G , Worrell S , Hayes P , Barnett CM , Glass D , Pido‐Lopez J , Imami N , Aspinall R , Dutton J , Gazzard B , Peters AM , Gotch FM 
Published: March 2004

ObjectivesWe aimed to provide evidence of thymic reconstitution after highly active antiretroviral therapy (HAART) in HIV‐1 infected patients and to correlate this with the restoration of peripheral naïve T cells.MethodsPositron emission tomography (PET) enables definitive evidence of thymic activity, indicating functional potential. In this case study, a single patient who initiatiated HAART demonstrated reconstitution of the naïve T‐cell pool and underwent thymic PET scans at baseline and 2 and 6 months following initiation of therapy. Two patients who failed to demonstrate such reconstitution acted as controls. These patients (mean age 27 years) had chronic HIV infection with low CD4 T‐cell counts (mean 82, range 9–160 cells/μL blood). Increased function of the thymus visualized by PET was correlated with phenotypic changes in CD4 and CD8 T cells in the periphery measured by flow cytometry, and with numbers of recent thymic emigrants measured by quantification of the numbers of T‐cell receptor excision circles (TRECs) in peripheral cells.ResultsIn one patient, clear correlations could be drawn between visible activity within the thymus, as measured by increased [F18]fluorodeoxyglucose (FDG) uptake, and regeneration of naïve CD4 (CD45RA/CD62L) T cells, increased numbers of CD4 T cells, controlled viraemia and increased numbers of recent thymic emigrants. A second patient displayed no increase in peripheral CD4 count and no increase in thymic activity. The third patient elected to stop therapy following the 2‐month time point.ConclusionsThe use of PET suggests that thymic activity may increase after HAART, indicating that the thymus has the potential to be functional even in HIV‐1 infected persons with low CD4 T‐cell counts.
A randomized open‐label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection
Authors: Moyle GJ , Lysakova L , Brown S , Sibtain N , Healy J , Priest C , Mandalia S , Barton SE 
Published: March 2004

BackgroundPolylactic acid (PLA, New‐Fill®; Medifill, London, UK and Dermic Labs, a division of Eventis, Strasbourg, France) injections into the deep dermis increase fibroblast numbers and collagen production. The substance is widely used in medical applications including cosmetic procedures.MethodsHIV‐positive individuals with facial lipoatrophy (based on physician assessment) were randomized to immediate (weeks 0, 2 and 4) or delayed (weeks 12, 14 and 16) PLA given as three bilateral injections 2 weeks apart into the deep dermis overlying the buccal fat pad. Assessments included facial ultrasound, visual analogue scales, the Hospital Anxiety and Depression Scale (HADS) and assessment using photographs at weeks 0, 12 and 24.ResultsAll 30 patients completed 24 weeks of treatment. The median age of the patients was 41 years, with a mean of 80 months of nucleoside reverse transcriptase inhibitor (NRTI) therapy and a mean of 44 months of prior protease inhibitor (PI) therapy. The median CD4 count was 428–460 cells/μL, with 47% of patients in the immediate‐treatment group and 93% of patients in the delayed‐treatment groups with<50 HIV‐1 RNA copies/mL at baseline. No differences in immunological, virological, biochemical, haematological or metabolic parameters emerged during the study. Injections were well tolerated with only two adverse events (cellulitis and bruising) recorded, one of which delayed treatment by 1 week. There were no discontinuations. Patient visual analogue assessments, photographic assessments, and anxiety and depression scores improved with treatment. At week 12, immediate‐treatment patients had significantly better visual analogue scores (7 vs. 1, P<0.001) and lower anxiety scores (6 vs. 9, P=0.056) than delayed‐treatment patients. Benefits on visual analogue and HADS scores persisted until week 24.ConclusionsPLA injections led to improvements in patient self‐perception, anxiety and depression scores in individuals with facial lipoatrophy. Adverse events were uncommon. The benefits of PLA persisted for at least 18 weeks beyond the last injection.
The high cost of medical care for patients who present late (CD4<200 cells/μL) with HIV infection
Authors: Krentz HB , Auld MC , Gill MJ 
Published: March 2004

ObjectiveTo compare the direct costs of medical care in the year following HIV diagnosis for patients who present with a CD4 count<200 cells/μL (‘late presenters’) and those who present with a CD4 count >200 cells/μL (‘early presenters’).MethodsDirect costs (i.e. drugs, laboratory tests, outpatient care, in‐patient care, and home care) for the 12 months following HIV diagnosis, sociodemographic data and clinical data were collected for all patients presenting for HIV care in Southern Alberta, Canada between April 1996 and April 2001. Mean costs are presented as costs in 2001 Canadian dollars.ResultsThirty‐nine per cent of 241 patients presented with a CD4 count <200 cells/μL. The mean costs for late presenters were more than twice as high as those for early presenters (i.e. $18 448 vs. $8455, respectively). Late presenters were more likely to be older, male and black, and to have a risk activity of men having sex with men (MSM) or heterosexual contact (P<0.05). However, the large difference in mean costs cannot be attributed to differences in characteristics. When characteristics were statistically held constant, the estimated excess cost of late presentation was almost unaffected, at $9723 (z=5.6). Repeating the analysis using disaggregated costing categories suggested that the difference in total costs was largely attributable to differences in HIV‐related hospital care costs, which were 15 times higher for late presenters.ConclusionsDirect care costs in the year following HIV diagnosis were more than 200% higher for patients who presented late. This difference could not be attributed to differences in patient characteristics. Most costs were attributable to HIV‐related hospital care costs and the immediate initiation of antiretroviral therapy. While early diagnosis in those at risk for HIV remains medically important, the short‐term economic impact is also substantial.
Nevirapine‐ versus efavirenz‐based highly active antiretroviral therapy regimens in antiretroviral‐naïve patients with advanced HIV infection
Authors: Manosuthi W , Sungkanuparph S , Vibhagool A , Rattanasiri S , Thakkinstian A 
Published: March 2004

ObjectiveTo compare virological and immunological responses to nevirapine (NVP)‐based and efavirenz (EFV)‐based highly active antiretroviral therapy (HAART) regimens in antiretroviral‐naïve patients with advanced HIV infection.MethodsA retrospective observational cohort study was conducted on antiretroviral‐naïve HIV‐infected patients whose pretreatment CD4 cell counts were less than 100 cells/μL or whose viral loads were greater than 100 000 HIV‐1 RNA copies/mL.ResultsBaseline characteristics of patients in the NVP (n=24) and EFV (n=29) groups were not different. The proportion of patients with viral loads >100 000 copies/mL was higher in the EFV group. The probability of virological success estimated by the Kaplan‐Meier method showed that 3‐ and 6‐month success rates were 30.8% [95% confidence interval (CI): 16.7–52.2%] and 63.1% (95% CI: 44.7–81.3%) for the NVP group. The corresponding values were 41.2% (95% CI: 25.8–61.0%) and 62.9% (95% CI: 45.7–80.1%) for the EFV‐based group. The median success times of the two groups were about 4 and 3 months (P=0.678), respectively, for NVP and EFV. Cox's proportional hazard was used after adjusting for age, previous opportunistic infections (OIs), and viral load at baseline, and showed that patients who received the NVP‐based regimen had about 25% [hazard ratio (HR)=0.75, 95% CI: 0.37–1.51] less chance of virological success than patients who received the EFV‐based regimen (P=0.415). The median times to CD4≥100 cells/μL were 5.6 and 4.4 months for the NVP‐ and EFV‐based regimens, respectively (log‐rank test, P=0.144).ConclusionsNVP‐ and EFV‐based HAART regimens as initial regimens in patients with advanced HIV infection are effective and comparable, in term of virological and immunological responses. However, further large‐scale randomized controlled clinical trials in this group of patients with advanced HIV infection are needed.
Laparovaginal hysterectomy: A decade of evolution
Authors: Cook Jennifer R. , O'Shea Robert T. , Seman Elvis I. 
Published: March 2004

AbstractObjective:  To compare surgical outcomes for laparoscopically‐assisted vaginal hysterectomy (LAVH) to total laparoscopic hysterectomy (TLH) and to document the modifications to the technique of laparovaginal hysterectomy which have occurred over the last decade at Flinders Endogynaecology, South Australia, Australia. The method of choice at the start of the decade was LAVH and by the end of the study period it had been superceded by TLH.Sample:  Seven hundred and ninety‐four consecutive women underwent hysterectomy between January 1992 and December 2001 at Flinders Endogynaecology. This included 424 women who underwent TLH and 370 who underwent LAVH.Methods:  Retrospective review of case history notes and manual extraction of data.Main outcome measures:  Demographic data including patient age, weight and parity were extracted. Intraoperative complications including ureteric injury, cystotomy, bowel damage or conversion to open procedure were recorded. The rate of non‐autologous blood transfusion was recorded and miscellaneous data including length of procedure, estimated blood loss, length of hospitalisation, concomitant procedures carried out and re‐admission rates were also recorded.Results:  There was a statistically significant reduction in major morbidity in the TLH group when compared to the LAVH group. The lower rate of conversion to laparotomy in the TLH group was statistically significant (3.0 vs 0.9%). A non‐significantly higher rate of ureteric injury was observed in the TLH group (0.7 vs 0.3%). Other outcome measures showed a trend toward an improved outcome for TLH but were not statistically significant. This includes a lower rate of bowel injury in the TLH group (0 vs 0.3%), a lower rate of cystotomy in the TLH group (1.4 vs 3.0%) and lower rate in non‐autologous blood transfusion in the TLH group (1.2 vs 3.0%). There was a statistically significant reduction in hospital stay from 4.5 days in the LAVH group to 3.4 days in the TLH group.Conclusion:  The evolution of laparovaginal hysterectomy from LAVH to TLH over the last 13 years has resulted in improved patient outcomes. Ongoing modification of the technique to ensure ureteric protection must remain a priority.
Laparoscopic treatment of enterocele: A 3‐year evaluation
Authors: Cook Jennifer R. , Seman Elvis I. , O'Shea Robert T 
Published: March 2004

AbstractObjective:  To report the morbidity associated with the laparoscopic treatment of enteroceles and assess the durability of the repair.Design:  Prospective observational study.Setting:  University Teaching Hospital.Population:  Forty‐five consecutive women with symptomatic enteroceles who underwent laparoscopic treatment of an enterocele.Main outcome measures:  Objective urogynaecological assessment using the pelvic organ prolapse quantification system.Results:  The 11% incidence of anterior wall prolapse is lower than that associated with previous reports of surgical procedures to treat enterocele. There is a 4.4% incidence of major complications. The procedure has been demonstrated to have a 93% success rate at 3 years in treating enterocele.Conclusion:  The laparoscopic enterocele sac excision and vaginal vault suspension fulfils Richardson's requirements for surgical correction of enterocele and provides an anatomic solution to the long‐standing surgical dilemma of enterocele.
Veda‐scope: More comfortable than the bivalve speculum and cytologically equivalent
Authors: Longmore Peter G. 
Published: March 2004

AbstractObjective: The aim of the present study was to confirm that the Veda‐scope is equivalent to the bivalve speculum in the collection of endocervical cells, as confirmation of adequate cervical sampling for Pap smear testing. The study also aimed to assess the comfort level of the Veda‐scope compared to the traditional bivalve speculum and the patient preference of the Veda‐scope compared to the bivalve speculum.Methodology: Multicentre, randomised, controlled crossover, cytologist blinded study.Population: The total number of subjects enrolled in the study were 250. The number of evaluable subjects were 210.Results: In primary efficacy analysis, no significant difference was seen between the presence or absence of endocervical cells in the smears using either the Veda‐scope or the bivalve speculum. There was a high concordance level between the diagnosis assigned to each specimen of a paired sample, the diagnosis agreeing in 97.6% cases. The primary reason given by many women for avoidance of regular Pap smear examinations is the discomfort or pain experienced with sample collection with the bivalve speculum. In the present study, 92% of subjects indicated a preference for the Veda‐scope for Pap smear collection, while only 8.4% preferred the bivalve speculum. Subject preference was also assessed with respect to how the subject rated the comfort level of her previous Pap smear. In subjects who rated their previous Pap smear as very comfortable or comfortable, 86% expressed a preference for the Veda‐scope. This rose to 93% in subjects who rated their previous Pap smear as only tolerable.Conclusion: The results of the present study show that Pap smear collections with the Veda‐scope are of equal quality to those collected with the bivalve speculum, with an equivalent diagnostic outcome. A very strong preference for the Veda‐scope was shown by the women enrolled in the present study based on the comfort levels experienced with the two devices.
Voiding function after tension‐free vaginal tape: A longitudinal study
Authors: Dietz Hans Peter , Ellis Gaye , Wilson Peter Donald , Herbison Peter 
Published: March 2004

AbstractBackground:  The tension‐free vaginal tape (TVT) has become popular for the surgical treatment of urodynamic stress incontinence. It seems to function via an intermittent obstructive effect that is easily demonstrated on imaging, although there is no agreement regarding its effect on voiding.Aims:  The present study was designed to longitudinally evaluate flowmetry indices and voiding symptoms after TVT placement.Methods:  A total of 145 consecutive patients were seen at yearly intervals after TVT placement, and 108 have now attended at least twice. A standardised questionnaire was filled in and a clinical stress test performed. The patients were asked to void for flowmetry; ultrasound was performed translabially for residual urine, tape position and mobility.Results:  After TVT placement, maximum flow rate (MFR) centiles dropped from 49.66 (SD 32.45) to 22.86 (SD 23.56), P < 0.001. However, when first and last postoperative visits were compared, there was a significant increase in MFR centiles (20.07 (SD 20.83) to 24.92 (SD 23.94), P = 0.021). This effect appeared to be almost linear over time when analysed on anova. The residuals decreased highly significantly (P < 0.001). This was accompanied by a reduction in symptoms of voiding dysfunction such as ‘poor stream’ (P = 0.024), ‘straining to void’ (P = 0.038) and ‘incomplete emptying’ (P = 0.019).Conclusions:  The tension‐free vaginal tape reduces MFR and flow rate centiles. It can have an obstructive effect on voiding, although this does not appear to be a major clinical problem. Voiding seems to improve over time, and this is accompanied by a reduction in the prevalence of symptoms of voiding dysfunction.
Effects of oestrogen replacement therapy on serum C‐reactive protein levels in hysterectomised women
Authors: Kiran Hakan , Kiran Gurkan , Ekerbicer Hasan C. , Guven Alanur M. , Kilinc Metin 
Published: March 2004

AbstractBackground:  It has been hypothesised that oral oestrogen replacement therapy may increase levels of C‐reactive protein (CRP), a marker of inflammation associated with increased risk of future cardiovascular events. However, it is possible that intranasal oestrogen replacement therapy have different effects on serum CRP levels.Aim:  To investigate the effect of postmenopausal intranasal oestrogen replacement therapy on serum levels of CRP. A prospective comparative study was carried out.Methods:  Twenty‐nine healthy hysterectomised, postmenopausal women received 300 µg/day of intranasal 17β‐oestradiol (E2). The serum levels of CRP after 3 and 6 months after starting treatment were compared with baseline values.Results:  There were no significant changes in the values of CRP after 3 and 6 months of treatment (P = 0.305, P = 0.149, respectively).Conclusions:  The data from the present study suggest that intranasal administration of E2 does not affect CRP levels, possibly by avoiding a hepatic first‐pass effect. The possible cardiovascular protective role of intranasal oestrogen might be related to its effect of not increasing CRP levels.
Magnetic resonance imaging findings following three different vaginal vault prolapse repair procedures: A randomised study
Authors: Rane Ajay , Lim Yik Nyok , Withey Grant , Muller Reinhold 
Published: March 2004

AbstractObjective:  To compare the vaginal configuration on magnetic resonance imaging following transvaginal sacrospinous fixation (SSF), posterior intravaginal slingplasty (PIVS) (infracoccygeal sacropexy) and sacrocolpopexy (SCP).Materials and methods:  Twenty‐one patients with vault prolapse requiring surgical treatment were randomly assigned in a balanced way to undergo SSF (n = 7), PIVS (n = 7) or SCP (n = 7). The magnetic resonance imaging of the pelvis were performed preoperatively and at 6–12 weeks postoperatively to assess the vaginal configuration using the method described previously. The two main angles measured were: (i) the angle between the lower vagina and pubococcygeal line ‘d‐angle’ (normal: 53 ± 15°); and (ii) the angle between the lower and upper vagina planes ‘e‐angle’ (normal: 145 ± 7°).Results:  The mean preoperative/postoperatively measured d‐angles were 69°/62°, 58°/70°, and 49°/52° for SSF, PIVS and SCP, respectively. The corresponding means for the e‐angle were 173°/215°, 189°/146°, and 205°/149°. The changes of the e‐angles proved to be statistically significant (P < 0.05) in each surgical group, while no significant change in the d‐angle could be found in any of the three groups.Conclusions:  Significant improvements in the restoration of vaginal configuration were achieved in patients who underwent PIVS or SCP. Sacrospinous fixation in contrast seems to increase anatomical distortion of the vaginal configuration.
Case series of a single centre's treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination in 2002
Authors: Costello Michael F. , Emerson Sandra , Miranda Therese , Bakhtyari Mo Bashir , Clements Sarah , Hughes Graeme , Steigrad Stephen 
Published: March 2004

AbstractThe present paper reports a single department's retrospective case series of all clomiphene citrate (CC) combined with intrauterine insemination (IUI) treatment cycles for ovulatory infertility performed during 2002. Thirty‐eight couples with unexplained, endometriosis, male or unilateral tubal factor infertility had undergone 71 cycles of CC and IUI. The clinical and ongoing cycle pregnancy rates were 20 and 17%, respectively. Seven percent of the clinical pregnancies were multiple pregnancies, with all multiple pregnancies being twin gestations. The current use of CC and IUI is an effective early treatment option in couples with ovulatory infertility presenting to our department.
Will there ever be an end to the Caesarean section rate debate?
Authors: Dietz Hans Peter , Peek Michael J. 
Published: March 2004

AbstractCaesarean section rates continue to rise. To date, no serious attempt has been made to address this issue. There are no scientific grounds for identifying an ‘appropriate’ level for Caesarean section rates. A ‘Term Cephalic Trial’ may provide such information, but poses major logistic and ethical challenges. The authors propose that a combination of known and newly developed predictors of emergency operative delivery may allow an antenatal risk assessment that could make intervention trials both ethically sound and logistically feasible.
Hysterectomy and endometrial ablation in New South Wales, 1981 to 1999–2000
Authors: Yusuf Farhat , Siedlecky Stefania 
Published: March 2004

AbstractObjective:  To examine the trends in hysterectomy in New South Wales (NSW) from 1981 to 1999–2000 and the impact of endometrial ablation.Data:  Computerised discharge summaries from private and public hospitals for the years 1981, 1991, 1994–1995 and 1999–2000 obtained from the NSW Health Department. All records listing hysterectomy in women over the age of 20 in each period were selected and those listing endometrial ablation since 1991 were also selected. Operative procedure, diagnosis, hospital type, length of stay and demographic data were recorded. Annual figures since 1988–1989 for hysterectomy and ablation were also obtained.Findings:  Initially it appeared that the introduction of endometrial ablation might reduce hysterectomy rates, but the combined rate of hysterectomy and endometrial ablation continued to rise to a peak in 1992–1993 and has declined since. The hysterectomy rate in 1999–2000 was lower than in 1981. There has been a marked shift from abdominal to vaginal hysterectomy, with an increase in laparoscopically assisted operations. Overall, the mean age at operation has been rising, although the mean age for vaginal hysterectomy has fallen. The shift to private hospitals and reduction in hospital stay have continued.Conclusion:  The trends are consistent with the increased use of laparoscopic and ablation techniques, improvements in hormonal contraceptive use, and better access to abortion, which have facilitated women's decisions to postpone their births and to conserve their childbearing to older ages. Further development of these techniques will have an impact on gynaecological training and practice in the next decade.
In vivo PLT increments after transfusions of WBC‐reduced PLT concentrates stored for up to 7 days
Authors: Dijkstra‐Tiekstra M.J. , Pietersz R.N.I. , Hendriks E.C.M. , Reesink H.W. , Huijgens P.C. 
Published: March 2004

BACKGROUND: Bacterial screening and improvement of storage conditions of leukoreduced PLT concentrates (LR‐PCs) allows extension of their storage period from 5 to 7 days.STUDY DESIGN AND METHODS: For in vitro studies, 40 LR‐PCs made from five buffy coats and plasma were studied for 8 days. For in vivo studies, routinely produced LR‐PCs stored for 2 to 7 days after blood collection were administered to clinically stable thrombocytopenic patients. CI1 h was calculated after 353 transfusions (67 patients), and CCI1 h, after 195 transfu‐sions (55 patients), with pretransfusion PLT counts of not greater than 20 × 109 per mL.RESULTS: Storage experiments showed that the pH of LR‐PCs remained greater than 6.8 for 8 days, provided that the PLT concentration was less than 1.3 × 109 per mL. Routinely produced LR‐PCs had a volume of 282 ± 15 mL (n = 10,193) and contained 329 × 109± 40 × 109 PLTs (n = 3467). For 7‐day‐old LR‐PCs, 76 of 78 (97%) of the transfusions resulted in a CI1 h of at least 10 and 37 of 39 (95%) in a CCI1 h of at least 7.5, which indicated levels for successfulness. Mean ± SE values of CI1 h and CCI1 h of 7‐day‐old LR‐PCs were 28.7 ± 2.3 (n = 78) and 19.0 ± 2.0 (n = 39), respectively. No significant differences were observed between 5‐ and 7‐day‐old LR‐PCs transfused with respect to CI1 h and CCI1 h values.CONCLUSION: In vitro and in vivo studies showed that LR‐PCs can be stored for up to 7 days with excellent clinical results, provided that they are routinely screened for bacterial contamination.