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Prevention with tamoxifen or other hormones versus prophylactic surgery in BRCA1/2-positive women: a decision analysis.

PURPOSE: Recent randomized controlled trials have shown that tamoxifen and raloxifene may prevent invasive breast cancer. This decision analysis study compares the outcomes of chemoprevention with tamoxifen, raloxifene, or oral contraceptives with the outcomes of prophylactic surgery among women with high-risk BRCA1/2 mutations. PATIENTS AND METHODS: We used a simulated cohort of 30-year-old women who tested positive for BRCA1/2 mutations and constructed a Markov model with Monte Carlo simulations, incorporating cumulative breast and ovarian cancer incidence rates from the literature and survival figures from SEER data. We assumed that prophylactic surgery reduces ovarian cancer risk by 45% and breast cancer risk by 90%, that tamoxifen reduces invasive breast cancer risk by 49%, and that raloxifene has similar efficacy and safety in premenopausal and postmenopausal women. We used data obtained from high-risk women by a time trade-off questionnaire to calculate quality-adjusted life-years. We based our cost estimates for hospital and ambulatory care on Health Care Financing Administration payments, the SEER-HCFA database, and the Pharmacy Fundamental Reference. RESULTS: In our model, a 30-year-old BRCA1/2+ woman could prolong survival by 0.9 years (95% probability interval, 0.4-1.2 years) by having bilateral oophorectomy, 3.4 years (2.7-3.7 years) by having bilateral mastectomy, and 4.3 years (3.6-4.6 years) by having both procedures instead of surveillance alone. Chemoprevention with tamoxifen and raloxifene increased survival by 1.6 years (1.0-2.1 years) and 2.2 years (1.3-2.8 years), respectively. Chemoprevention yielded more quality-adjusted life-years than did prophylactic surgery, even when treatment was delayed to age 40 or 50 years. All these procedures were cost-effective or cost-saving compared with surveillance alone. DISCUSSION: Our model suggests that although surgery may yield more substantial survival and cost benefits, quality of life issues may make chemoprevention a more attractive option for young women at high genetic risk.

Adult↗

PubMed2000

[Psychological consequences of breast cancer screening among healthy women].

The number of healthy women undergoing screening for cancer is very large. It is therefore important to know about the psychological consequences of screening. The literature for this review was found by searching in national and international databases and reading lists of references. This review finds that both women with negative test results and women with false positive test results report on psychological consequences such as fear and raised anxiety, depression, impaired working capacity, reduced self-esteem and self-confidence, as well as effects on their relationship to other people. They also report on physical symptoms such as impaired sleep or appetite. This review suggests that methods other than psychometric questionnaires would offer more knowledge on the subject and that future research should concentrate on those women experiencing serious psychological effects of screening.

Breast Neoplasms↗

PubMed2000

Detrusor pressure uroflowmetry studies in women: effect of a 7Fr transurethral catheter.

PURPOSE: We evaluated whether a 7Fr transurethral catheter affects urinary flow in women undergoing pressure flow studies for voiding symptoms. MATERIALS AND METHODS: We reviewed a urodynamic database of 600 consecutive women referred for the evaluation of voiding symptoms. Before urodynamics all patients voided privately using a standard toilet and free flow was recorded. Urodynamics were performed using a 7Fr double lumen transurethral catheter. At functional bladder capacity patients were asked to void in the sitting position and pressure flow studies were performed. All uroflowmetry tracings were inspected and analyzed manually. Only patients who voided similar volumes varying by less than 20% on the free and pressure flow studies were assessed. Free and pressure flow parameters were compared according to voided volume category, main urodynamic diagnosis, uroflowmetry pattern and pre-void bladder volume. RESULTS: A similar volume was voided on the free and pressure flow studies of 100 women. In each voided volume category and urodynamic diagnosis pressure flow parameters were significantly different from the equivalent free flow parameters in all but 4 cases. Specifically the maximum flow rate was significantly less and flow time was significantly longer on pressure versus free flow studies (each p <0.01). An intermittent flow pattern was more common on pressure than in free flow measurements (43% versus 9%). CONCLUSIONS: A 7Fr transurethral catheter may adversely affect uroflowmetry parameters in women undergoing pressure flow studies for lower urinary tract symptoms. This finding may have further clinical implications regarding the interpretation of these parameters as well as establishment of an accurate diagnosis.

Aged↗

PubMed2000

Retinal nerve fiber layer thickness in human strabismic amblyopia.

BACKGROUND AND PURPOSE: Amblyopia is characterized by histopathological changes in the visual cortex and lateral geniculate nucleus. In the retina, however, no abnormalities have yet been reported. The purpose of this study was to compare the nerve fiber layer (NFL) thickness in the amblyopic eye with that in the sound eye of patients with strabismic amblyopia. As a practical implication, we investigated the validity of comparing Nerve Fiber Analyzer (NFA) measurements obtained in amblyopic eyes to the normative database built into the NFA. METHODS: NFL thickness was measured with a third generation NFA, the GDx (Laser Diagnostic Technologies, San Diego, CA). This is a scanning laser polarimeter, designed for monitoring glaucoma. The following NFL thickness parameters (all in microns) were compared: average thickness, superior maximum, inferior maximum, superior average, inferior average, nasal median and temporal median. Twenty patients with strabismic amblyopia were imaged with the NFA. Patients had no nystagmus, neurological disease or glaucoma. Nine patients had amblyopia in the right eye, and 11 patients in the left eye. RESULTS: In general, the sound eyes yielded higher thickness measures than the amblyopic eyes. These differences, however, were small, averaging only 1.5%, p = 0.6, and therefore not "statistically significant" at the p&le 0.05 level. CONCLUSIONS: Using the standard of "Statistical Significance = p< or =0.05", when amblyopic eyes are measured with the NFA, the built-in normative database may serve as the reference data

Adolescent↗

PubMed2000

Gnathostoma spinigerum: analysis of protein patterns by two dimensional gel electrophoresis.

The protein extracts from male (MS) and female (FS) adults and advanced third-stage larvae (LS) of Gnathostoma spinigerum were separated by high resolution two-dimensional gel electrophoresis (2-DE). The polypeptide spots, as detected by silver staining, were subsequently identified. The spot patterns of LS, MS and FS were highly complex and consisted of more than 75, 44, 52 prominent spots, respectively. In addition, the stage-specific protein patterns were identified. This 2-DE database should provide an important reference for future biological and biochemical studies of G. spinigerum.

Animals↗

PubMed2003

Pacifier use and early childhood caries: an evidence-based study of the literature.

This evidence-based study of the literature investigated the relationship between pacifier use (with and without sweetening and prolonged or short-term) and early childhood caries (ECC). The review was based on evidence from 3 main sources: a search of several electronic bibliographic databases, a review of the references from relevant studies for additional potentially relevant articles and a review of several dental textbooks. A total of 74 articles were reviewed. Of these, 8 were deemed relevant and were critically appraised according to a "causation checklist" of 13 items. The 8 studies assessed were methodologically inconsistent in terms of definitions of ECC, diagnostic criteria for identifying carious lesions, dental examination procedures, interviewing methods, and descriptions of pacifier use. None of the studies achieved a score greater than 6 and hence none was considered to present strong evidence. Six studies did not control for confounding variables, and the conclusions they generated were inconsistent. The evidence from the other 2 studies, which did control for confounding factors, presented slightly stronger evidence, but they indicated no statistical difference in pacifier use between children with and those without ECC; furthermore, the reported odds ratios suggested that pacifier use might have had a mildly protective effect. Overall, the evidence does not suggest a strong or consistent association between pacifier use and ECC.

Child, Preschool↗

PubMed2003

Critical appraisal of endometriosis management for pain and subfertility.

OBJECTIVE: To critically appraise current best available management of pain and subfertility ascribable to endometriosis. METHODS: Medline and specialist computer databases were searched along with reference lists of known reviews and primary articles to identify cited articles not captured by electronic searches. We included all studies pertaining to treatment of pain and subfertility ascribable to endometriosis. DISCUSSION: Medical and surgical management options for pain and subfertility are presented as Evidence-based inquiries for critically appraised topics. Each problem is presented as an answerable question followed by assessment of literature search for level of evidence. This is followed by critical appraisal of results. In the end, take-home answer to individual problem is presented in view of best available evidence. CONCLUSION: Evidence-based management of endometriosis provides realistic therapeutic goals and expectations for the clinicians and women experiencing pain and subfertility due to this disease. It also promotes efficient and effective use of medical and surgical options when required.

Adult↗

PubMed2003

Identification of human remains by immobilized sequence-specific oligonucleotide probe analysis of mtDNA hypervariable regions I and II.

AIM: A rapid analysis of mitochondrial DNA (mtDNA) sequences with an array of immobilized sequence-specific oligonucleotide (SSO) probes was tested on 18 skeletal elements recovered from mass graves in Croatia, which could not be genotyped with common forensic nuclear DNA systems (PM+DQA1 and short tandem repeat analysis). METHODS: We used duplex polymerase chain reaction (PCR) amplification of the mtDNA hypervariable regions I and II (HVI and HVII) (444 bp and 415 bp amplicons, respectively) and subsequent linear array typing, which targets six polymorphic regions and two additional sites within the human mtDNA HVI and HVII. The remaining amplified products were subjected to direct sequence analysis to obtain complete sequence information for the targeted HV regions. RESULT: Duplex PCR amplification of the mtDNA HVI and HVII was successful in providing sufficient product for typing with the array of SSO probes in 14 out of the 18 sample extracts. We report here the sequence match of one set of remains with a panel of immobilized SSO probes, followed by direct sequence analysis. The corresponding mtDNA haplotype obtained for the bone sample and the putative maternal reference was unique in a database of 105 randomly selected Croatian individuals. CONCLUSION: Mitochondrial DNA typing with an array of immobilized SSO probes can be a benefit to forensic DNA analysis of mass disaster remains and identity testing of single and mass graves.

Blood Stains↗

PubMed2003

A prospective study of 32 patients with neurosarcoidosis.

BACKGROUND AND AIM: There are few published prospective studies of neurosarcoidosis. To establish the incidence of neurological involvement and the response to treatment in patients presenting with sarcoidosis. METHODS: From 1991 to 1994, 123 patients were studied prospectively at the Prince Charles Hospital using a purpose designed computerised database (1). Consecutive patients were referred for neurological and psychiatric assessment when clinically indicated. Nerve conduction studies were done to confirm the presence of peripheral neuropathy. RESULTS: Neurological involvement was identified in 32/123 patients (15 male, 17 female, all white), mean age 48 years, age range 21-80 years. Of the 32 patients, the following frequencies of abnormalities were observed: papilloedema (6%), cranial neuropathy (59%), peripheral neuropathy (47%), mononeuropathy (25%), myopathy (25%), psychiatric disorders (19%), cerebellar ataxia (13%), and hydrocephalus (6%). A neurological improvement was seen in 16/19 (84%) of our patients as a result of therapy, and in 5/13 (38%) who were untreated. Corticosteroid treatment was used in 19/32 patients, with 6/32 requiring pulse intravenous methylprednisolone for initial poor response. The most predictable response incurred in patients with peripheral neuropathy; 12/14 treated patients responding. Only 1/8 patients who remained untreated for this, improved spontaneously. CONCLUSION: Neurological involvement was found more commonly than previously reported (26%). Corticosteroid treatment was found to be effective, although the response was often slow. High dose intravenous methylprednisolone was useful in poor responders (2). Peripheral neuropathy responded predictably to treatment. A formal neurological examination is recommended in all patients with sarcoidosis as neurological involvement may be overlooked.

Adrenal Cortex Hormones↗

PubMed2003

[Treatment of collagenous colitis. An analysis of a systematic Cochrane review].

BACKGROUND: Collagenous colitis is a disorder that is recognized as a cause of chronic diarrhea. Treatment has been based mainly on anecdotal evidence. This review was performed to identify therapies for collagenous colitis that have been proven in randomized trials. OBJECTIVES: To determine effective treatments for patients with clinically active collagenous colitis. SEARCH STRATEGY: Relevant papers published between 1970 and October 2002 were identified via the MEDLINE, PUBMED, and EMBASE databases. Manual searches from the references of identified papers, as well as review papers on collagenous or microscopic colitis were performed to identify additional studies. Abstracts from major gastroenterological meetings were searched to identify research submitted in abstract form only. Finally, the Cochrane Controlled Trials Register and the Cochrane Inflammatory Bowel Disease Group Specialized Trials Register were searched for other studies. SELECTION CRITERIA: Four randomized trials were identified. One trial studied bismuth subsalicylate (published in abstract form only), and 3 trials (1 published in abstract form only) studied budesonide in the therapy of collagenous colitis. DATA COLLECTION AND ANALYSIS: Data were extracted independently by each author onto 2 x 2 tables (treatment versus placebo and response versus no response). For therapies assessed in one trial only, p-values were derived using the chi-square test. For therapies assessed in more than one trial, summary test statistics were derived using the Peto odds ratio and 95% confidence intervals. Data were combined for analysis only if the outcomes were sufficiently similar in definition. MAIN RESULTS: There were 9 patients with collagenous colitis in the trial studying bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks). Those randomized to active drug were more likely to have clinical (p = 0.003) and histological (p = 0.003) improvement than those assigned to placebo. A total of 94 patients were enrolled in 3 trials studying budesonide (9 mg daily for 6 to 8 weeks). The pooled odds ratio for clinical response to treatment with budesonide was 12.32 (95% CI 5.53-27.46), with a number needed to treat of 2 patients. There was significant histological improvement with treatment in all 3 trials studying budesonide therapy. REVIEWERS' CONCLUSIONS: Budesonide is effective in the treatment of collagenous colitis. The evidence for bismuth subsalicylate is weaker, but still important. The roles of these and other therapies in inducing or maintaining remission (as opposed to clinical or histological improvement) of collagenous colitis are unknown.

Anti-Inflammatory Agents↗

PubMed2005

[Caring for teenage girls: from the perspective of establishing women's health consultations on campuses].

Women's health problems are increasing among teenage girls in modern society. However, there are only a few programs related to women's health consultation on campuses. Three issues are explored in this paper - the health rights of teenage girls, women's health consultations, and teenage girls' subjective views about the establishment of a women's health consultation service on their campus. In the course of our research of teenage girls' subjective views, three hundred and eighty-seven young girl students responded to questionnaires and seven volunteer students among them were invited to do in-depth interviews. Most students (98.2%) thought that it was necessary to set up a women's health consultation service on campus, because they hoped to get personal health information that could not be found in a textbook. Three hundred and five (78.8%) students perceived that they had women's health problems. Their health problems are ranked as follows: dysmenorrhea, irregularity of menstrual periods, unusual vaginal secretions and questions of contraception and urinary system health. They suggested that campus consultation centers should have the following characteristics: protection of students' privacy, provision of multiple channels for consultation, strict limitation on numbers of people in the consulting office, and a non-discriminatory policy towards all clients. Hopefully, an information database can provide a good reference for establishing a women's health consultation service on campus in the near future.

Adolescent↗

PubMed2005

Sports massage. A comprehensive review.

The science of sports massage is of interest to many populations including athletes, athletic trainers, coaches, as well as sports physiologists. While evidence to support or refute the effects of massage on sports performance is insufficient to make definitive statements, new reports and trends within data help formulate an understanding of sports massage. This article will review sports massage research on topics including lactate clearance, delayed onset of muscle soreness (DOMS), muscle fatigue, the psychological effect of massage, and injury prevention and treatment. Articles referenced in Medline, Cochrane Database, the authors library, and references from articles are included in this review. Most studies contain methodological limitations including inadequate therapist training, insufficient duration of treatment, few subjects, or over or under working of muscles that limit a practical conclusion. Muscle soreness associated with DOMS is reduced with massage, although whether force recovers more quickly is still unclear. The research literature to date is insufficient to conclude whether massage facilitates recovery from a fatiguing effort. Both tissue healing and a psychological effect of massage are areas that may prove promising with further research. Results from published literature support a positive trend for massage to benefit athletic recovery and performance; a need for further research into sports massage, especially well-designed studies utilizing therapists specifically trained to administer this type of therapy, is warranted.

Humans↗

PubMed2005

[A systematic review of multifactorial interventions for primary prevention of delirium in the elderly].

Delirium is a severe psychiatric syndrome that is highly prevalent in elderly patients in a general hospital. Primary prevention is important to prevent delirium. This article reviews recent developments with regard to multifactorial intervention trials for primary prevention of delirium. The review process involved a systematic search in MEDLINE, The Cochrane Database and CINAHL Database and subsequent examination of reference lists. Six studies were selected. Four studies showed that systemic interventions regarding medical-, nurse-led, environmental-, and educational items, were effective in preventing delirium. In one study a reduction was found in duration and severity of duration only. One study showed no effect on delirium at all. Despite the methodological weaknesses of the studies, conclusions are that different kinds of non-pharmacological interventions can be effective in preventing delirium.

Aged↗

PubMed1990

Effectiveness of Haemophilus influenzae type b vaccines.

PURPOSE: To determine the clinical effectiveness of Haemophilus influenzae type b (Hib) vaccines. STUDY IDENTIFICATION AND SELECTION: Computerized searches of MEDLINE, EMBASE and SCISEARCH databases were performed, and the reference list of each retrieved article was reviewed. Two prospective clinical trials of Hib polyribosyl ribitol phosphate conjugated with diphtheria toxoid (PRP-D) were identified. In addition, one cohort study of the PRP-D vaccine, two trials of the PRP vaccine, five case-control studies of the PRP vaccine and 10 randomized controlled trials of the immunogenicity of the PRP-D vaccine were identified. DATA EXTRACTION: Study quality was assessed and descriptive information concerning the study populations, the interventions and the outcome measurements was extracted. RESULTS: The difference in the effectiveness of the PRP-D vaccine between the prospective trials, in which a three-dose schedule had been used beginning at 2 to 3 months of age, was clinically important (37% v. 83%) but not statistically significant. The PRP vaccine, which induces lower antibody responses than the PRP-D vaccine does, was clinically effective only in a subgroup of one prospective trial; 90% effectiveness was reported among children 18 to 60 months of age. CONCLUSIONS: Hib vaccine appears to be less effective in high-risk populations. None the less, because of the large variation in baseline risk, the number of children who would have to be vaccinated to prevent one case of invasive Hib disease is substantially less for high-risk than for low-risk populations. The vaccination of children at high risk, such as native children, with the PRP-D vaccine using a four-dose schedule (at 2, 4, 6 and 14 months of age) seems warranted. The currently available evidence does not strongly support a policy of universal vaccination with either a one-dose or a four-dose schedule.

Alaska↗

PubMed1990

The use of grey literature in health sciences: a preliminary survey.

The paper describes some initiatives in the field of grey literature (GL) and the activities, from 1985, of the Italian Library Association Study Group. The major categories of GL are defined; a survey that evaluates the use of GL by end users in the health sciences is described. References in selected periodicals and databases have been analyzed for the years 1987-1988 to determine the number of articles citing GL, the number of GL citations found in selected periodicals, the various types of GL found, and the number of technical reports cited and their country of origin and intergovernmental issuing organization. Selected databases were also searched to determine the presence of GL during those same years. The paper presents the first results obtained.

Databases, Bibliographic↗

PubMed1995

Quantitative volumetric analysis of brain MR: normative database spanning 5 decades of life.

PURPOSE: To present a normative volumetric database, spanning 5 decades of life, of cerebrospinal fluid, subarachnoid cerebrospinal fluid, total brain volume, total ventricular volume (component ventricular volumes of lateral, temporal horn, and third and fourth ventricles) and estimates of white and gray matter, based on a multispectral segmentation of brain MR. This database is presented as a reference for future studies comparing pathologic states. METHOD: One hundred ninety-four healthy subjects, ranging in age from 16 to 65 years, received standard axial intermediate- and T2-weighted spin-echo MR images. Multispectral segmentation and volume analysis were performed using ANALYZE. RESULTS: Normative volumetric estimates, both uncorrected and corrected for differences in total intracranial volume, were obtained for all subjects and presented by decade and sex. Age-related cerebrospinal fluid changes were evident for both male and female subjects. Most gender differences were eliminated by correction for differences in total intracranial volume. Standard and fast spin-echo acquisition methods gave comparable volume estimates. Total brain volume measurements from MR compare favorably with data from large autopsy series. CONCLUSION: Although there may be limitations to generalizations, these normative data tables can provide a comparison index for contrasting pathologic groups with a normative sample.

Adolescent↗

PubMed1995

[Iontophoresis in the treatment of pain].

UNLABELLED: The objective has been to verify the effectiveness of iontophoresis in alleviating conditions of pain by means of a computer-assisted search of the pertinent literature. The search was performed with the aid of the Medline database (1984 bis 1993) and reference lists (studies from 1954). SELECTION CRITERIA: all clinical trials performed with at least one control group as well as all experimental studies conducted within the same period. The selection criteria were met by 10 experimental and 15 clinical studies. The studies were categorized by substance group. The following groups of substances were applied (experimentally/clinically): local anaesthetics (0/6), non steroidal anti-inflammatory drugs (2/3), vinca-alkaloids (1/2), corticosteroids (3/1), morphine (0/1), iodide (4/1) and fluoride (0/1). Both short-term effects (lidocaine, procaine, flufenamic acid, morphine) and long-term effects (benzocaine-salicylamide, diclofenac, Mobilat, vinca-alkaloids, dexamethasone-lidocaine, iodide, fluoride) were studied. Comparisons were made against placebo iontophoresis (lidocaine, procaine, flufenamic acid, diclofenac, Mobilat, vinca-alkaloids, dexamethasone-lidocaine, morphine, fluoride), solely topical administration (procaine, benzocaine-salicylamide, flufenamic acid), placebo administration without current (procaine, flufenamic acid), and other methods (lidocaine, iodide). With one single exception (lidocaine), none of the studies included groups without treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics↗

PubMed1996

[Selected parameters of lipoprotein metabolism in cerebrovascular diseases].

In series of patients with stroke, selected by random (n = 68), mean age 62.44 +/- 9.12 years (range 39-82 yrs), there were 23 females (33.8%), mean age 65.43 +/- 10.11 yrs and 45 males (66.2%) mean age 60.8 +/- 8.3 yrs. Lp(a) reference values have been obtained from a group of 283 healthy individuals (age ranging from 15 to 65 years). The cholesterol, triacyglycerol, Apo B reference values come from the database of the Department of Clinical Biochemistry. There were 52 hypoxemic stroke patients in the whole observed group. Triacylglycerol serum level TAG < or = 2.89 mmol/l was observed in 47 cases (90.3%), the serum level TAG > 2.89 mmol/l was present in 5 cases (9.7%). The occurrence of TAG normal serum level was significantly more frequent than its pathologic increase (p < 0.001). Apolipoprotein Apo B < or = 1.67 g/l serum level was present in 41 (78.8%) and Apo B > 1.67 g/l in 11 (21.2%) cases (p < 0.001). Apo B < or = 1.67 g/l serum levels in 23 cases (82.1%) and Apo B > 1.67 g/l in 5 cases (18%) were observed among the stroke diabetes mellitus patients (n = 28)--statistic difference in 1/1000 level. In the total hypoxemic stroke group (n = 52), Lp(a) < or = 0.278 g/l was observed in 44 cases (84.6%), Lp(a) > 0.278 g/l serum level was present in 8 cases (15.4%)/ - p < 0.001. According to EASD consensus the serum level of Lp(a) = 0.278 g/l has been considered as "cut-off limit". Similar distribution of Lp(a) serum levels was observed in the diabetes mellitus stroke group (n = 28), the ischemic heart group (n = 54), the group with aortosclerosis (n = 16) and in the group with arterial hypertension (n = 50). Elevated TAG serum levels were not in correlation with the number of sites where atherosclerotic changes were proved by arteriography, ultrasound investigation e.g. in the extracranial brain supplying arteries. Elevated Lp(a) serum levels did not correlate with the stage of ischemic heart disease and they correlated with the stage of functional CNS defect in arterial hypertension and atherosclerosis. Metabolic disorders of lipoprotein and apolipoprotein, namely genomic transcription of lipoprotein seem to be more significant risk stroke factors, but, if they are present, they contribute to the occurrence of arteriosclerosis of some larger arteries. Elevated Lp(a) serum levels did not correlate with the stage of the heart ischemic disease and aortosclerosis, but they correlate with the stage of functional CNS defect due to arteriosclerosis and arterial hypertension, hence the increase in Lp(a) serum level as an indicator of arteriosclerotic evolution of cerebral arteries is significant. Our results, hence, do confirm a common supposition for Lp(a) serum level as an independent arteriosclerotic risk factor of the brain arteries. (Fig. 7, Tab. 1, Ref. 22.)

Adolescent↗