Search PubMed⌕ Search

Biomedical subjects

J Paavonen

Publications and source records attributed to J Paavonen.

At least 73 records · Page 4Linked to original sources
PubMed1999

MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US.

PURPOSE: To assess the value of magnetic resonance (MR) imaging in the diagnosis of pelvic inflammatory disease (PID) and to compare MR imaging with transvaginal ultrasonography (US) and laparoscopy. MATERIALS AND METHODS: Thirty consecutive patients hospitalized because they were clinically suspected of having PID underwent transvaginal US and T1-weighted spin-echo, T2-weighted turbo spin-echo, and inversion-recovery MR imaging at 1.5 T. All patients underwent laparoscopy after MR imaging. RESULTS: PID was laparoscopically proved in 21 (70%) patients. The MR imaging diagnosis agreed with that obtained with laparoscopy in 20 (95%) of the 21 patients with PID. The imaging findings for PID were as follows: fluid-filled tube, pyosalpinx, tubo-ovarian abscess, or polycystic-like ovaries and free pelvic fluid. Findings at transvaginal US agreed with those at laparoscopy in 17 (81%) of the 21 patients with PID. The sensitivity of MR imaging in the diagnosis of PID was 95%, the specificity was 89%, and the overall accuracy was 93%. For transvaginal US, the corresponding values were 81%, 78%, and 80%. CONCLUSION: MR imaging is more accurate than transvaginal US in the diagnosis of PID and provides information about the differential diagnosis of PID. MR imaging may reduce the need for diagnostic laparoscopy.

Adolescent↗
PubMed1998

Cost-benefit analysis of first-void urine Chlamydia trachomatis screening program.

OBJECTIVE: To perform a cost-benefit analysis of a Chlamydia trachomatis screening program based on first-void urine testing of asymptomatic women using a polymerase chain reaction (PCR) test. METHODS: A decision tree was developed. Selected variables based on assumptions were subjected to sensitivity analyses to make the model accurate and defensible. RESULTS: Screening for chlamydial infections using the PCR test was shown to be cost-effective even in low-prevalence populations. Compared with a symptom-driven no-screening situation, a universal C trachomatis screening program using the PCR test would save money, in terms of direct cost, when the baseline prevalence of C trachomatis infection exceeds 3.9%. CONCLUSION: Cost analyses are still rare among trials that compare pharmacologic or procedural health care interventions. Socioeconomic studies linking secondary prevention of C trachomatis infection and infertility and adverse pregnancy outcome are needed to convince public health authorities of the need for and the benefit of such programs.

Adolescent↗
PubMed1998

Pelvic inflammatory disease. From diagnosis to prevention.

Pelvic inflammatory disease (PID) refers to infection of the uterus, fallopian tubes, and adjacent pelvic structures that is not associated with surgery or pregnancy. PID causes major medical, social, and economic problems worldwide. Long-term sequelae, most notably tubal factor infertility and ectopic pregnancy, are common and extremely costly to the healthcare system. The most important causative micro-organisms are Chlamydia trachomatis, Neisseria gonorrhoeae, and micro-organisms associated with bacterial vaginosis. The clinical spectrum of PID ranges from subclinical endometritis to severe salpingitis, pyosalpinx, tubo-ovarian abscess, pelvic peritonitis, and perihepatitis. Clinical diagnosis of PID has limitations. The clinical diagnostic criteria are insensitive and nonspecific, and false-positive and false-negative diagnosis is common; however, direct visual diagnosis is not always feasible, requires general anesthesia, and is costly. More research is needed of noninvasive diagnosis of PID. Current treatment guidelines call for broad-spectrum antimicrobial coverage. Screening for asymptomatic chlamydial infection is the mainstay of prevention of PID. Emerging evidence from randomized controlled trials provides strong evidence that intervention with selective screening for chlamydial infection effectively reduces the incidence of PID.

Anti-Bacterial Agents↗
PubMed1998

Humoral immune response to conserved epitopes of Chlamydia trachomatis and human 60-kDa heat-shock protein in women with pelvic inflammatory disease.

The association between humoral immunity to unique and conserved epitopes of the Chlamydia trachomatis 60-kDa heat-shock protein (hsp60) and immunity to human hsp60 was examined in 129 women with laparoscopically verified pelvic inflammatory disease. An ELISA was used to detect antichlamydial IgG and IgA antibodies, IgG antibodies to recombinant human hsp60, and antibodies to two synthetic peptides of chlamydial hsp60. Half of the patients had antibodies to human hsp60, which correlated with the presence of antibodies to the chlamydial hsp60 peptide 260-271 homologous to the human hsp60 (P = .01). Antibodies to peptide 260-271 were associated with antichlamydial IgG (P < .0001) and IgA (P < .0001). The results suggest that the autoimmune response to human hsp60 can develop following C. trachomatis upper genital tract infection in women, probably as a consequence of an immune response to an epitope of chlamydial hsp60 cross-reactive with the human hsp60.

Amino Acid Sequence↗
PubMed1998

Can serology diagnose upper genital tract Chlamydia trachomatis infections? Studies on women with pelvic pain, with or without chlamydial plasmid DNA in endometrial biopsy tissue.

BACKGROUND: Upper genital tract chlamydial infections in women are on the increase, and serology might be a convenient tool for diagnosis. Evaluations of this approach are needed in women with or without microbiologic evidence of organisms in the upper genital tract. GOALS: To compare the results of antibody assays with cervical culture and upper genital tract histopathology in women with pelvic pain and chlamydial plasmid DNA in endometrial biopsies. STUDY DESIGN: Chlamydia trachomatis plasmid DNA was detected by polymerase chain reaction (PCR) on extracted deparaffinized endometrial biopsy tissue. Five antichlamydial antibody assays were performed measuring total antibodies or immunoglobulin G (IgG), IgM, and IgA classes on sera from 14 women with plasmid DNA as well as 31 without plasmid DNA. RESULTS: Accepting the presence of plasmid DNA as the gold standard, no single test had total diagnostic accuracy. The best sensitivity and specificity occurred with the following assays: whole inclusion fluorescence (WIF) (100% and 80.6%); microimmunofluorescence IgM (MIF IgM) (78.6% and 93.6%); and heatshock protein-60 enzyme immunoassay (42.9% and 100%). Although recombinant anti-lipopolysaccharide enzyme-linked immunosorbent assays measured anti-chlamydial antibodies in a large proportion of these women, specificity was low. The sensitivity and specificity of cervical culture was 28.6% and 100% and of endometrial histopathology was 71.4% and 48.4%. Analysis of patient serological profiles suggested that and 6 women without plasmid DNA may have been cases that were missed by PCR. CONCLUSIONS: Evaluations of assays to diagnosis Chlamydia trachomatis upper genital tract infections could use the presence of organisms or their markers in the upper genital tract as a standard of comparison. Some of these serological assays, such as WIF or MIF IgM, may be helpful in diagnosis, but more studies are needed.

Antibodies, Bacterial↗
PubMed1998

Rapid decrease of endemic gonorrhea in Finland.

OBJECTIVES: The incidence of gonorrhea has decreased in several European countries while a recent epidemic has occurred in Russia and the Baltic countries. In 1990, Finland had a higher gonorrhea incidence than the other Nordic countries. Therefore we studied prospectively the epidemiology of gonorrhea with special reference to the endemic or imported source of infection. STUDY DESIGN: The study included three gonorrhea patient series from STD clinics in Helsinki in 1990 to 1995. Each series covered a 12-month period. Case controls with Chlamydia trachomatis infection were included. Demographic and epidemiological findings, including source partner profiles, were analyzed. RESULTS: Gonorrhea decreased rapidly during the study period. In 1990 to 1991, there were 490 patients (3.3% of all patient visits); in 1992 to 1993, 162 (1.3%); and in 1994 to 1995, only 92 patients (0.9%) with gonorrhea. The change in the prevalence was highly significant (p < 0.0001) and was entirely because of the decreased number of endemic infections. The rate of imported gonorrhea remained constant with 50 to 60 patients, although traveling had increased markedly to Russia and Estonia where the incidence of gonorrhea was very high. Thirty-one percent of the patients with endemic gonorrhea but only 14% with imported gonorrhea (p < 0.0001) had a concomitant C. trachomatis infection. The prevalence of chlamydia decreased from 10.2 to 8.1% (p < 0.001), but in contrast to gonorrhea the source of infection was mainly endemic (89% to 97%) during the whole study period. The patients with gonorrhea were older and had a higher frequency of casual source partners than those with chlamydia. Overall, from 80% to 74%) of the men and from 48% to 33% of the women had contracted infection from a casual partner. CONCLUSION: The present study documented a rapid decrease of endemic gonorrhea in Finland, whereas the rate of imported gonorrhea remained constant. Demographic findings or source partner profiles of patients with gonorrhea or chlamydia gave no obvious explanation for the rapid decline of endemic gonorrhea, which is in sharp contrast to C. trachomatis infection.

Adolescent↗
PubMed1998

Pre-operative serum level of tumour-associated trypsin inhibitor and residual tumour size as prognostic indicators in Stage III epithelial ovarian cancer.

OBJECTIVE: To evaluate the use of the pre-operative tumour-associated trypsin inhibitor (TATI) level and residual tumour size at primary surgery as a prognostic indicators for patients with Stage III epithelial ovarian cancer. DESIGN: Retrospective cohort study. SETTING: Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland. PARTICIPANTS: Ninety-eight women with Stage III ovarian cancer. METHODS: TATI was measured by radioimmunoassay from serum samples obtained within one week before surgery. A cutoff value of 22 microg/L was used. Multivariate analysis included pre-operative TATI level, age, histologic grade and histologic type. Mantel-Cox test was used for calculating statistical significance of differences in survival between groups. MAIN OUTCOME MEASURES: Cumulative five-year survival, pre-operative serum TATI level and residual tumour size. RESULTS: Surgery was optimal (residual tumour size < or = 2 cm) in 55 patients and suboptimal (residual tumour size > 2 cm) in 43. Pre-operative TATI level < or = 22 microg/L predicted better prognosis both in patients with optimal and suboptimal surgery compared with patients with pre-operative TATI level > 22 microg/L. Patients with optimal surgery and a pre-operative TATI > 22 microg/L had a twofold relative risk of death compared with those with a pre-operative TATI < or = 22 microg/L. The cumulative survival was less than three years for patients with suboptimal surgery and pre-operative TATI > 22 microg/L. CONCLUSIONS: Pre-operative serum TATI in combination with residual tumour size may be useful in stratifying patients with Stage III ovarian cancer into different categories in randomised treatment trials.

Adult↗
PubMed1998

Comparison of performances of two commercially available tests, a PCR assay and a ligase chain reaction test, in detection of urogenital Chlamydia trachomatis infection.

The diagnostic performance of a PCR test (Roche Cobas Amplicor CT/NG Test) and that of a ligase chain reaction (LCR) test (Abbott LCx Chlamydia trachomatis assay) were compared by using endocervical and urethral swab specimen culture as a reference test. First-void urine (FVU) and endocervical and urethral swab specimens were collected from 1,015 unselected patients attending a sexually transmitted disease clinic and a clinic for adolescents in Helsinki, Finland. Chlamydia trachomatis was cultured from samples from the endocervix or urethra. PCR was performed with fresh and frozen urine and the culture transport medium. LCR was performed with fresh and frozen urine and LCx swab transport medium. Diagnostic consistency and diagnostic accuracy were statistically tested. The test results were identical for 984 patients (97%). Discrepant results were observed for 31 patients. Overall, LCR and PCR showed excellent kappa coefficients of consistency for both swab and FVU specimens (0.93 and 0.95, respectively). Sixty-one patients (6%) were culture positive. Testing of FVU by LCR or PCR increased the overall positivity rates to 7.0 and 7.7%, respectively. While PCR of FVU detected the greatest number of C. trachomatis infections (sensitivity, 96.1%), for some PCR-positive FVU specimens the results could not be confirmed (specificity, 99.6%). PCR and LCR were more sensitive than culture (sensitivities, 92 and 93% versus 79% for culture) in the diagnosis of genital C. trachomatis infection. In conclusion, both tests can be recommended for use in the clinical laboratory and for the screening of asymptomatic C. trachomatis infections.

Cervix Uteri↗
PubMed1998

Detection of Chlamydia trachomatis antibodies by 2 novel tests: rELISA and peptide EIA.

The performance of 2 newly developed enzyme immunoassays (EIAs) intended for the routine serological diagnosis of chlamydial infections was evaluated. rELISA is based on a recombinant lipopolysaccharide antigen which detects chlamydia genus-specific antibodies, and Chlamydia trachomatis EIA is based on a peptide derived from major outer membrane protein and is therefore species-specific. Both tests distinguished patients with tubal factor infertility (TFI) or pelvic inflammatory disease (PID) from the controls. The prevalence of IgA antibodies was higher for the PID patients than for the TFI patients; the finding indicates a more active state of infections for the PID patients. Furthermore, C. trachomatis EIA detected more IgG antibodies in the TFI patients than in patients with non-tubal factor infertility. In conclusion, rELISA detected chlamydial antibodies in general, and C. trachomatis EIA detected species-specific antibodies. These EIA tests may be useful in the serodiagnosis of chlamydial infection.

Adult↗
PubMed1998

Combined laboratory and diary method for objective assessment of menstrual blood loss.

BACKGROUND: To develop an objective measurement system for menstrual blood loss applicable in clinical practice. METHODS: One hundred and fifty-six patients were enrolled in a randomized trial of the treatment of menorrhagia in all five gynecology departments of the university teaching hospitals in Finland. Correlation between venous blood hemoglobin concentration (Hb) and absorbance at 564 nm (A564) was investigated in experiments with blood samples. Amount of collected menstrual blood and menstrual diary data were analyzed. RESULT: Hb concentration and A564 of the blood were linearly correlated (r=0.99). One hundred and fifty-four women (99%) returned used sanitary protection and menstrual diaries. On average, 12% (range 0-57%) of menstrual blood was lost during collection. The median amount of blood recovered from sanitary protection was 89 ml (range 14-724 ml), with 58% (n=90) of the women exceeding 80 ml per cycle. When the spilled blood was taken into account, the corresponding figures were 104 ml (range 15-724 ml) and 66% (n= 101). CONCLUSIONS: The spectrophotometric measurement of venous blood in the conventional alkaline hematin method can be replaced by measurement of Hb concentration. All blood incompletely collected should be recorded. Objective measurement of menstrual blood loss can be applied in routine clinical practice.

Adult↗
PubMed1997

A prospective, seroepidemiological study of the role of human papillomavirus in esophageal cancer in Norway.

Infection with the human papillomavirus (HPV), notably HPV type 16, has been associated with esophageal cancer in seroepidemiological studies. To evaluate the consistency of the association, we performed a nested case-control study of HPV seropositivity and risk of esophageal cancer within a prospectively followed cohort of 300,000 Norwegian men and women who had donated blood samples to a serum bank. The data file of the serum bank was linked with the nationwide Cancer Registry of Norway to identify esophageal cancers diagnosed after donation of the serum sample. Fifty-seven cases and 171 matched controls were analyzed for antibodies to specific microorganisms, and odds ratios for developing esophageal cancer were calculated. There was an increased risk of developing esophageal cancer among HPV 16-seropositive subjects (odds ratio = 6.6; 95% confidence interval, 1.1-71) but not among Chlamydia trachomatis-seropositive subjects. Adjustment for the presence of serum cotinine, a marker of smoking habits, did not affect the estimates substantially. The seroepidemiological association between HPV 16 and esophageal cancer seems to be consistent in different countries.

Adult↗
PubMed1997

Prospective seroepidemiological study of role of human papillomavirus in non-cervical anogenital cancers.

OBJECTIVE: To evaluate the association between infection with the major oncogenic types of human papillomavirus and the risk of developing non-cervical anogenital cancers in a cohort followed up prospectively. DESIGN: Data from two large serum banks to which about 700,000 people had donated serum samples were followed up for a mean of 8 years. People who developed non-cervical anogenital cancers during follow up were identified by registry linkage with the nationwide cancer registries in Finland and Norway. Within this cohort a nested case-control study was conducted based on the serological diagnosis of infection with human papillomavirus types 16, 18, and 33. SUBJECTS: 81 cases and 240 controls matched for sex, age, and storage time of serum samples. MAIN OUTCOME MEASURES: Odds ratios of developing non-cervical anogenital cancers in presence of IgG antibodies to specific micro-organisms. RESULTS: Subjects seropositive for human papillomavirus type 16 had an increased risk of developing non-cervical anogenital cancers (odds ratio 3.1 (95% confidence interval 1.4 to 6.9)). Subjects seropositive for type 33 also had an increased risk (odds ratio 2.8 (1.0 to 8.3)) but not significantly after adjustment for infection with type 16. Seropositivity for human papillomavirus type 16 was associated with an increased risk of developing vulvar and vaginal cancers (odds ratio 4.5 (1.1 to 22)) and a strongly increased risk of developing preinvasive vulvar and vaginal lesions (odds ratio infinity (3.8 to infinity)). Seropositivity for human papillomavirus type 18 increased the risk of developing preinvasive lesions (odds ratio 12 (1.2 to 590)). High, but non-significant odds ratios for types 16 and 33 were seen for penile cancers. CONCLUSIONS: This study provides prospective seroepidemiological evidence that infection with human papillomavirus type 16 confers an increased risk of developing non-cervical genital cancers, particularly vulvar and vaginal cancers.

Adult↗