Increased CA-15.3 levels in the serum of patients with homozygous beta-thalassaemia and sickle cell/beta-thalassaemia.
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Anemia, Sickle Cell↗
Biomedical subjects
P Vassilakos
Publications and source records attributed to P Vassilakos.
[Diagnosis of septic loosening of hip prosthesis with LeukoScan. SPECT scan with 99mTc-labeled monoclonal antibodies].
Diagnosis of septic loosening of hip endoprosthesis with antigranulocyte scintigraphy (AGS) was analysed. Twenty-one hip prostheses were studied using laboratory tests and, in cases of elevated values, three-phase bone scan (BS) and AGS. Elective SPECT/CT scans were performed. Histologic and microbiologic exams verified the diagnosis. The AGS analysis revealed sensitivity, specificity and accuracy of value 1, while positive and negative predictive values were also 1. BS showed sensitivity of 1 and specificity of 0.33. In three cases, SPECT/CT scans corroborated the AGS interpretation. This diagnostic algorithm proved effective in the detection of septic loosening of hip prostheses. AGS can be avoided without risk of infection being overlooked.
Aged↗
Pre-eclampsia and peripartum cardiomyopathy in molar pregnancy: clinical implication for maternally imprinted genes.
Molar pregnancies are associated with increased maternal complications, notably pre-eclampsia, but peripartum cardiomyopathy has been rarely observed. Here we report on a 34-year-old woman, gravida 2 para 1, who presented to our obstetric clinic for routine screening at 16 weeks of gestation. Elevated maternal serum alpha-fetoprotein and free beta-human chorionic gonadotropin were observed. Amniocentesis revealed a triploid constitution (69,XXX) and ultrasound examination showed growth restriction, fetal anomalies, placentomegaly and a total placenta previa. On admission at 18 weeks' gestation, the patient developed vaginal bleeding and pre-eclampsia. She underwent a Cesarean delivery and 6 h later developed congestive heart failure requiring intensive care support. Molecular analysis of the conceptus and parental DNA demonstrated an excess of paternal genomic contribution. The over-representation of the paternal chromosome complement may support the role of genomic imprinting in the clinical course of this case.
Adult↗
Primary screening for cervical cancer precursors by the combined use of liquid-based cytology, computer-assisted cytology and HPV DNA testing.
Primary screening for cervical cancer precursors has considerably evolved with the introduction of new technology to improve the early detection of disease. The objective of this study was to elaborate a diagnostic pathway integrating liquid-based and computer-assisted cytology and human papillomavirus DNA testing to focus screening on women at risk which may be more cost-effective for the healthcare system. A single laboratory analysis was conducted during a 5-month period using liquid-based cytology followed by human papillomavirus DNA testing for women with an abnormal result or with previous abnormal cytology. Human papillomavirus prevalence was estimated by testing 909 consecutive unselected samples. All slides were then rescreened using automated cytologic testing and triaged into a high- or low-score group according to computer results. Of the 8676 slides scanned, 352 had a test result of atypical squamous cells of undetermined significance or worse. Two hundred and ninety-seven (84.3%) samples with an atypical squamous cells of undetermined significance or worse result and 100% of those with detection of high-grade squamous intraepithelial lesions and carcinomas (HSIL+) were triaged into the high-score group. The combination of instrument scores and human papillomavirus results indicated that 51.0% of high score/human papillomavirus-positive cases should be considered as ASCUS+, while 99.6% of low-score/human papillomavirus negative cases remained negative in the final cytologic diagnosis, representing 49.0% of all cases. Of the screened women 89.5% should test negative for human papillomavirus and be reported as such in the final cytologic diagnosis. In conclusion, preliminary results suggest that this diagnostic pathway has the potential to improve primary cervical cancer screening and cost-effectiveness. By using a combination of testing methods to focus screening and clinical attention to cases at risk, it would be possible to lengthen screening intervals for 90% of women and to archive without further review all low-score/human papillomavirus-negative slides, representing 50% of the screening workload.
Cohort Studies↗
High- and intermediate-risk human papillomavirus infection in sexually active adolescent females.
STUDY OBJECTIVE: To determine the prevalence of high- and intermediate-risk type human papillomavirus (HPV) infection and cervical dysplasia in an urban Swiss adolescent population attending the local Adolescent Clinic, using a liquid-based Pap test combined with risk type HPV DNA testing. To determine the prevalence of Chlamydia trachomatis in the same study population. DESIGN: Observational study. SETTING: The Adolescent Clinic of the Department of Obstetrics and Gynaecology at the University Clinic, Geneva, Switzerland. PARTICIPANTS: 134 women between 14 and 20 years of age were enrolled in the study. MAIN OUTCOME MEASURES: A standardized patient file on demographic and sexual history information was compiled and completed by physical examination, including a Pap test with adjunct high- and intermediate-risk type HPV DNA detection. RESULTS: Of the 134 specimens analyzed for HPV, 115 patients were negative and 19 (14.2%) were positive for HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, or 68. A significant association between HPV infection and having had more than one lifetime sexual partner was found (P <.05). Six (31.6%) of the HPV-positive and three (2.6%) of the HPV-negative specimens had a low-grade squamous intraepithelial lesion (SIL) by cytology. Abnormal Pap test was related to HPV infection (odds ratio, 46.2; 95% confidence interval, 7.4 to 287.4) and, inversely, to age at first sexual intercourse (odds ratio, 0.98; 95% confidence interval,.97 to 1.0). CONCLUSION: High- and intermediate-risk type HPV infection is a frequent finding in our study group and is linked to having had more than one lifetime sexual partner. No association was found between HPV infection and other potential risk factors such as patient's age, age at first intercourse, frequency of intercourse during the three months prior to the investigation, smoking habits, or alcohol consumption.
Adolescent↗
Novel application of IGF-I and IGFBP-3 generation tests in the diagnosis of growth hormone axis disturbances in children with beta-thalassaemia.
OBJECTIVE: Children with beta-thalassaemia major (beta-thal) frequently have growth retardation in the presence of low serum IGF-I and a normal GH response to pharmacological stimulation suggesting that they have GH insensitivity (GHIS). This study was carried out to study the cause of their growth retardation. DESIGN: We studied IGF-I and IGFBP-3 generation after exogenous GH administration for four days, in 15 prepubertal controls (C) and 41 prepubertal beta-thal patients divided into three groups according to their growth status: (Group 1) 15 with normal growth (N-thal) (Group 2) 16 with decelerated growth (D-thal) and (Group 3) 10 with short stature (S-thal), in order to determine whether GHIS is the cause of their growth retardation. MEASUREMENTS: IGF-I and IGFBP-3 were measured daily, before and for 4 days after daily administration of 0.1 IU/kg hGH, in 3 groups of prepubertal beta-thal patients and normal controls. RESULTS: N-thal and C had similar basal serum IGF-I (142 +/- 52 and 196 +/- 56 ng/ml, respectively) and IGFBP-3 concentrations (2.07 +/- 0.49 and 2.66 +/- 0.41 mg/l, respectively) as well as a similar percent increase of IGF-I (101 +/- 23% and 104 +/- 37%, respectively) and IGFBP-3 (52 +/- 36%, and 38 +/- 14%, respectively) during the generation tests. S-thal and D-thal had significantly lower basal IGF-I and IGFBP-3 concentrations (85 +/- 42 and 101 +/- 36 ng/ml; and 1.60 +/- 0.49 and 1.79 +/- 0.52 mg/l, respectively) as compared to N-thal and C (P < 0.001 and P < 0.005, respectively), and a significantly higher percent increase of IGF-I and IGFBP-3 during the generation tests (249 +/- 43 and 161 +/- 76%; and 121 +/- 99 and 73 +/- 35%, respectively) as compared to N-thal and C (P < 0.0001 and P < 0.01, respectively). Twenty-five percent of the growth retarded patients had classic GH deficiency (GHD) and percent increases of IGF-I and IGFBP-3 in the generation tests (164 +/- 86% and 80 +/- 49%, respectively) which were similar to those of the remaining growth-retarded children. CONCLUSION: The greater percent increases of IGF-I and IGFBP-3 in the generation tests of the growth retarded beta-thal patients, both with and without GHD, strongly suggest impaired GH secretion rather than GHIS as the cause of their growth retardation. We conclude that the IGF-I and IGFBP-3 generation tests are useful tools for the study not only of GHIS but also of GH secretory disorders in patients with beta-thal and short stature that can easily be performed in an outpatient setting as an initial test to identify the patients that may benefit from GH therapy.
Adolescent↗
Combined screening for Chlamydia trachomatis and squamous intra-epithelial lesions using a single liquid-based cervical sample.
BACKGROUND: Cervicitis is believed to alter cytological interpretation and could compromise a combined screening for Chlamydia trachomatis (CT) cervicitis and squamous intra-epithelial lesions (SIL). Liquid-based cytological methods have been shown to limit obscuring factors and permit the detection of infectious agents by DNA amplification techniques. The aim of this study was to evaluate a combined screening for SIL and CT cervicitis with a single liquid-based cervical sample. METHODS: Two cervical samples were obtained from each of 590 women considered at high risk for CT. The modified Ligase chain reaction (LCR) procedure for CT detection using specimens collected in the AutoCyte's preservative fluid was compared with the conventional Abbott LCx method using cervical swabs. We have also compared the percentage of inflammatory specimens and adequacy of cellular material in the populations of CT+ and CT- women. RESULTS: The results show total agreement for 588 of 590 cervical samples using the two LCR protocols (Kappa = 0.96; 95% confidence interval: 0.91-1.00). The quality of cervical cytology was not compromised by CT cervicitis. CONCLUSIONS: We demonstrated the feasibility of combined screening for CT and SIL with a single liquid-based cervical sample.
Adult↗
Biopsy-based comparison of liquid-based, thin-layer preparations to conventional Pap smears.
OBJECTIVE: To evaluate and compare histologic diagnosis of squamous intraepithelial neoplasia and cancer of the cervix with cytologic diagnosis using the conventional Pap smear versus the AutoCyte PREP liquid-based, thin-layer preparation. STUDY DESIGN: Two randomly selected, large patient groups from the same population were studied using two different cervical cytology preparation techniques. Cytologic results were compared to histologic diagnosis to estimate the relative sensitivities and specificities of the preparations. RESULTS: AutoCyte's liquid-based, thin-layer preparation method demonstrated improved agreement with histologic diagnosis as compared to the conventional Pap smear. This result supported the previously reported finding that use of this thin-layer method reduced atypical squamous cells of undetermined significance cases and substantially increased the detection of squamous intraepithelial lesions (SILs). CONCLUSION: Our cytohistologic correlation for conventional Pap smears and the AutoCyte PREP liquid-based preparations demonstrate that the increased rate of both low and high grade SILs on AutoCyte PREP reflects real detection as opposed to overdiagnosis.
Biopsy↗
Obstructive uropathy versus nephropathy: compartmental analysis in radioisotopic renography as a new methodology.
A study was carried out to determine the spatial-temporal distribution of the radiopharmaceutical, 99mTc-DTPA in the kidney and its compartments during renography and the use of compartmental analysis to improve the diagnostic capability of renography. A total of 60 individuals formed three groups: group A consisted of 30 normals taken as controls, group B consisted of 15 patients with unilateral nephropathy, and group C consisted of 15 patients with unilateral obstructive uropathy. This retrospective study was performed by processing of the frames acquired in the various stages of renography and determination of the time distribution of radioactivity in the aorta, the renal parenchyma and the renal pelvis. The data acquired were used to produce three curves instead of one for each kidney and to study renal function as a system of six compartments (aorta, left and right renal parenchyma, left and right renal pelvis, and bladder). In all the above compartments the differences among the three groups were significant and were quantified using the flow coefficients of the aortorenal compartments. The differences between the aortic flow coefficients (k1) were statistically significant not only between normal controls and patients, but also between individuals with parenchymatic dysfunction and patients with pelvocalyceal obstruction. The same differences were seen comparing the pelvocalyceal coefficients (k3) of all three groups. The parenchymatic coefficient (k2) presented statistically significant differences between normals and patients which were not observed between the two groups of patients (B and C). Compartmental analysis thus increases the sensitivity of renography, is objective by utilizing quantitative parameters, enables the separate analysis of the functional behavior of the various renal compartments, and improves the differential diagnosis between parenchymatic dysfunction and pelvocalyceal obstruction.
Adolescent↗
Cord blood alpha-fetoprotein concentrations in term newborns of smoking mothers.
UNLABELLED: To investigate the toxic effect of tobacco smoke on the fetus, we measured in cord blood the concentrations of alpha-fetoprotein (AFP), the principal serum protein in early ontogenic development, and erythropoietin (EPO), as an index of chronic fetal hypoxia. A total of 103 consecutively enrolled term newborns of smoking mothers and 103 term infants of nonsmoking parents were studied. The mean +/- SD AFP concentrations in the newborns of the mothers who smoked 1-50, 5-50, and 10-50 cigarettes/day were 86.4 +/- 88.9, 96.3 +/- 91.9 and 118.7 +/- 103.7 ng/ml, respectively. The difference of all three groups from the control neonates (57.7 +/- 37.2) was significant. The EPO concentrations in the newborns of the mothers who smoked 1-50 (53.9 +/- 64.6 mU/ml) and 5-50 (56.3 +/- 68.5) cigarettes/day were significantly greater than in the control neonates (29.5 +/- 16.1). In the newborns of the smoking mothers there was a significant positive correlation between AFP concentrations and number of cigarettes smoked per day, and a negative correlation between AFP and birth weight or length. There was no correlation between AFP and EPO concentrations, as well as between EPO and birth weight, length or number of cigarettes smoked per day. CONCLUSION: The absence of a correlation between erythropoietin and birth weight or length and the negative correlations between alpha-fetoprotein and these anthropometric parameters suggest that the intra-uterine growth retardation caused by maternal smoking is not due to tissue hypoxia, but that both growth retardation and elevated alpha-fetoprotein result from the direct or indirect toxic effect of a factor(s) present in tobacco smoke.
Analysis of Variance↗
Association between activation of the renin-angiotensin system and secondary erythrocytosis in patients with chronic obstructive pulmonary disease.
PURPOSE: An association between activation of the renin-angiotensin system and enhanced erythropoiesis has been observed in patients with several diseases, including congestive heart failure and hypertension. Our goal was to examine whether the renin-angiotensin system is associated with secondary erythrocytosis in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Plasma renin activity, plasma aldosterone concentration, serum erythropoietin level, and serum angiotensin converting enzyme (ACE) activity were measured in 12 patients with COPD and secondary erythrocytosis [mean (+/-SD) hematocrit of 53% +/- 3%] and in 12 matched controls with COPD who did not have erythrocytosis (hematocrit 45% +/- 5%). All patients had chronic hypoxemia (PaO2 <60 mm Hg). RESULTS: Both plasma renin and aldosterone levels were threefold greater in patients with secondary erythrocytosis compared to controls. No difference in erythropoietin levels was observed between patients with or without secondary erythrocytosis. Renin levels (r = 0.45; P = 0.02) but not erythropoietin levels (r = 0.15; P = 0.47) were correlated with hematocrit in the entire sample. Renin levels and PaO2 were the only variables independently and significantly associated with hematocrit values in a multiple linear regression model. CONCLUSION: Activation of the renin-angiotensin system is associated with the development of secondary erythrocytosis in chronically hypoxemic patients with COPD. The exact mechanism is not yet fully understood, but angiotensin II may be responsible for inappropriately sustained erythropoietin secretion or direct stimulation of erythroid progenitors.
Aged↗
Human papillomavirus (HPV) DNA assay as an adjunct to liquid-based Pap test in the diagnostic triage of women with an abnormal Pap smear.
OBJECTIVE: The diagnostic performance and clinical value of the combined use of liquid-based Pap test and human papillomavirus testing were determined in 336 patients with a previous abnormal smear. METHOD: Subsequent histologic evaluation was used as definitive diagnosis. RESULT: The combined use of liquid-based Pap test and HPV DNA testing showed higher rates in sensitivity (99.0%), specificity (59.3%), positive predictive value (89.9%) and negative predictive value (94.5%) than either cytology alone (sensitivity 98.8%, specificity 45.7%, positive predictive value 84.7%, negative predictive value 92.6%) or HPV DNA testing alone (sensitivity 84.9%, specificity 67.4%, positive predictive value 88.8%, negative predictive value 59.5%). CONCLUSION: The study demonstrated that the diagnostic accuracy for cervical cancer and its precursors was improved by using the liquid-based Pap test as a primary diagnostic procedure and HPV assay as an adjunctive test. This information may assist the clinicians in triaging patients with equivocal cytologic cervical atypias.
Adolescent↗
[Screening of cervical cancer, false negative smears].
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False Negative Reactions↗
Relationship between left ventricular hypertrophy and plasma renin activity in chronic hemodialysis patients.
Left ventricular hypertrophy (LVH) is very common in uremic patients. It was shown previously that hemodialysis patients are chronically exposed to the extremes of plasma renin activity due to differences in the original renal disease. Because nonhemodynamic factors seem to play a fundamental role in the development of LVH, the present study was undertaken to investigate the relationship between the predialysis renin level and the echocardiographically determined cardiac structure in stable hemodialysis patients, matched for other parameters known to participate in the development of LVH, such as age; gender; body mass index; interdialytic weight gain; heart rate; systolic, diastolic, and mean arterial BP; hematologic and biochemical profile; vascular access; adequacy of dialysis; nutritional status; and period of follow-up. Thirty-three such patients were stratified in three groups according to predialysis renin levels: group A (n = 11), with renin levels < or = 1 ng.ml-1.h-1; group B (n = 9), with renin levels between 1 and 4 ng.ml-1.h-1; and group C (n = 13), with renin levels > or = 4 ng.ml-1.h-1. LVH with disproportionate septal thickening was directly related to the degree of renin-angiotensin system activation, and values for interventricular septum thickness, posterior wall thickness, interventricular septum thickness/posterior wall thickness ratio, left ventricular mass, and left ventricular mass index were all significantly correlated with predialysis renin levels. Because angiotensin II promotes growth in both fibroblasts and cardiac myocytes, these relationships suggest that elevated renin levels may be causally associated with the development of LVH in chronic hemodialysis patients.
Analysis of Variance↗
[Cervical cancer screening. False negative smears].
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Algorithms↗
The prognostic value of DNA ploidy and S-phase estimate in primary breast cancer: a prospective study.
In this prospective study, the independent prognostic value of DNA ploidy in combination with the major clinico-pathological characteristics (histological grade, nodal status, tumor size, estrogen and progesterone receptor status, number of tumors, multicentricity, lympho-vascular infiltration) was evaluated in a series of 399 breast-cancer patients. The mean follow-up time was 4.5 years. The DNA content was measured using image cytometry on fresh tumor samples. The overall survival of tetraploid and slowly proliferating diploid cases was significantly different compared with that of aneuploid and rapidly proliferating diploid cases (p = 0.0002). Thus, DNA ploidy combined with S-phase estimate (DNA histogram type) appeared to be good prognostic factors. In a multivariate survival analysis, DNA histogram type was not an independent prognostic factor unless the histological grade was excluded. This effect of DNA histogram type on survival was also observed among patients with grade-I or -II tumors and patients with small tumors. In conclusion, DNA histogram type was a valuable prognostic factor in univariate analysis, and provided independent complementary information for patients considered at low or intermediate risk by classical pathological findings.
Adenocarcinoma↗
Herpetic endometritis after pregnancy.
A case of endometrial herpex simplex virus infection with severe uterine post-partum bleeding is reported. Histopathologic analysis of curettage samples revealed endometrial necrosis and diffuse herpes-type nuclear inclusions in the glandular epithelial cells. Immunohistochemistry, in situ hybridisation, and electron microscopy confirmed the diagnosis.
Adult↗
In vivo estimation of radiation dose in renal pelvis and parenchyma during renography.
A method is presented for the determination of the spatio-temporal distribution of the radionuclide in the kidney and estimation of the dose in the renal pelvis wall and parenchyma, during renograms, on the basis of real data. A protocol was formulated by means of which the processing of the frames acquired in the various stages of the renogram enables the determination of the mass of the renal pelvis and the parenchyma as well as the time distribution of radioactivity in these compartments. The proposed methodology was applied to 30 normal subjects and 35 patients with obstructive nephropathy, acute and chronic obstructive uropathy and hydronephrosis. Our results, when compared with the MIRD dose estimations for the entire kidney showed slight deviations in normals, whereas very significant deviations were observed in the cases with pathology. This is due to the fact that the mass of the 'source' and 'target' organs as well as the biodistribution of the radiopharmaceuticals are essential in dose determination and were completely different in our calculations from those used in the MIRD estimations. Comparing the absorbed dose in renal parenchyma and pelvis wall with that estimated in vivo for the kidney considered as a system of one compartment, we found large differences only in abnormal cases. Differences were also noted between the absorbed dose in the aforementioned renal compartments depending on the considered abnormal renal states.
Adult↗