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Objective: This paper describes improvements and updates to an established approach to making epidemiological estimates of HIV prevalence in countries with low level and concentrated epidemics. Methods: The structure of the software used to make estimates is briefly described, with particular attention to changes and improvements. Discussion: The approach focuses on identifying populations which, through their behaviour, are at high risk of infection with HIV or who are exposed through the risk behaviour of their sexual partners. Estimates of size and HIV prevalence of these populations allow the total number of HIV infected people in a country or region to be estimated. Major changes in the software focus on the move away from short term projections and towards developing an epidemiological curve that more accurately represents the change in prevalence of HIV over time. The software continues to provide an output file for use in the Spectrum software so as to estimate the demographic impact of HIV infection at country level. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 41-year-old woman who underwent surgical hysteroscopy was admitted to hospital due to high-grade endometrial stromal sarcoma. Physicians have conducted ultrasonography, surgical hysteroscopy and preoperative magnetic resonance imaging (MRI) to evaluate the extrauterine extension of the tumor. It found that hysteroscopy method is very effective to assess an early diagnosis of sarcomas.

The article reports on the study that describes the villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix. It presents a case that provides an opportunity to review the diagnosis and treatment of VGPA and the factors that may influence the prognosis of women diagnosed with the histological type of cervical cancer. It suggests the significance to keep in mind the prognostic factors because it may have a negative effect on tumor behavior and the progression of the disease.

The application of an individualised dosimetric procedure for radioiodine therapy requires the intensive use of resources in nuclear medicine facilities. In practice, the amount of data taken per patient is too limited to obtain an accurate estimate of the absorbed dose in the thyroid. The individualised absorbed dose estimates can be enhanced using statistical tools for population-based approaches. The aim of this work was to build a population biokinetic model of thyroid uptake and elimination of radioiodine using a nonlinear mixed-effects approach in patients with Graves' disease. Input data for the model development were taken from a dosimetric method based on 123 I imaging data. 123 I decay-corrected uptake values were estimated at 4, 24, and 96 h post-administration and for 58 patients. The root mean squared error (RMSE) for predicted 123 I uptake values by the fitted model was 4%. The root mean squared error of prediction (RMSEP) for out-of-sample 123 I uptake values, computed by a leave-one-out cross-validation, was 12%. We calculated 131 I activity to administer from out-of-sample predicted 123 I uptake values and compared the result with that calculated from observed 123 I uptake values. RMSEP values for therapeutic activity revealed that there were measuring points with higher weight than others in the model. The mixed-effects approach can be used to enhance the accuracy of dosimetric calculations in therapies using 131 I. Assessing the accuracy of the predictive model enables choosing among different time-sampling schedules of the radioiodine thyroid uptake curve. This methodology can also be applied in other areas of radiation dosimetry., (Copyright © 2019 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Objective/hypothesis: This study examined correlations between surgical recommendations based on either drug-induced sleep endoscopy (DISE) or common awake examination methods in patients with obstructive sleep apnea syndrome (OSAS)., Study Design: Prospective, blinded, clinical trial at a university hospital., Methods: An otorhinolaryngologist designed surgical plans for patients with OSAS after clinical examination, lateral cephalometry, the Müller maneuver, and Friedman staging. A second otorhinolaryngologist blinded to the previous plans made surgical recommendations after DISE. A third person tested agreement between the two sets of plans using Cohen's kappa statistic and the chi-squared test., Results: One hundred and sixty-two patients (15 females, 147 males) completed the protocol. Good correlation was observed between DISE and Friedman staging regarding recommendations for isolated oropharyngeal or multilevel surgery (kappa = 0.61). Correlations between DISE and clinical examination, lateral cephalometry, and the Müller maneuver regarding surgical procedures on specific structures contributing to upper airway obstruction ranged from fair for velum/tonsil surgery (k = 0.41-0.60) to poor (k = 0.01-0.20) for tongue-base, lateral pharyngeal wall, and epiglottal surgery. The most informative value was DISE versus clinical evaluation, lateral cephalometry, and the Müller maneuver, which changed surgical recommendations concerning the structures contributing to hypopharyngeal or laryngeal obstruction in > 40% of patients., Conclusions: Our results indicate that DISE provides more information about the anatomical locations and pattern of obstruction, particularly regarding the specific structures contributing to hypopharyngeal and laryngeal obstruction. DISE changes surgical decision making compared to awake evaluation methods., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Currently, cryopreservation of oocytes, embryos and ovarian tissue is considered the basis of fertility preservation programs for women with cancer and other diseases who are rendered sterile by gonadotoxic drugs or radiation.Numerous studies have confirmed that autograft of frozen-thawed ovarian tissue can restore ovarian function and fertility. A total of twenty-two live births have been reported but we still have to consider this technique as experimental. The main problem is that the implant undergoes ischemia until neoangiogenesis is restored, resulting in significant follicular loss.At the moment, there are numerous publications in different medical fields that publish successful experiences with plasma rich in platelets (PRP) in different clinical situations promoting angiogenesis. Thus, we considered the possibility of using it in the field of ovarian autologous transplantation in order to improve the vascularization of the implant and its quality. For this, both thawed ovarian tissue as practiced pockets on the rear side of the broad ligament which have been placed, have been impregnated with PRP. We can say that the implant treated in this way has had a rapid and successful response.We report a special interesting case because this is the first time that this technique is performed successfully in a woman without ovaries combined with growth factors to promote neoangiogenesis. Obviously, the results of the hormonal response come exclusively from the implanted tissue in these special conditions.

Objective: Reduced growth before birth is known to associate with a smaller ovarian volume in adolescents and women without androgen excess. We studied whether prenatal growth relates also to ovarian size and polycystic ovary (PCO) morphology in nonobese adolescents and young women with ovarian androgen excess., Design: A cross-sectional analysis of standardized case notes over a 2-yr period was performed., Patients: Nonobese adolescents and young women (age approximately 17 yr; n = 86) seen for ovarian androgen excess, as confirmed by 17-hydroxy-progesterone hyperresponse to a GnRH agonist, were included in the study., Measurements: Endocrine-metabolic assessment in fasting state, together with a vaginal ultrasound scan to verify the presence or absence of PCO was performed. Birth weight and gestational age were derived from medical records., Results: PCO prevalence by ultrasound was 38%. Absence of PCO was associated with a shift (P < 0.0005) of the birth weight distribution toward lower values. Patients with a birth weight less than 3.0 kg were 6-fold more likely to have no PCO than to have PCO. Birth weight was across a wide range (1.5-4.0 kg) associated with ovarian volume in hyperandrogenic patients with noncystic ovaries (r = 0.60; P < 0.00001) and was, in a multiple regression analysis, the prime variable linked to ovarian volume (beta = 0.57; P < 0.00001), explaining 32% of its variance., Conclusions: The ovarian size and the development of a PCO morphology in nonobese adolescents and young women with ovarian androgen excess relate to prenatal growth. These findings indicate that there are two subgroups of nonobese patients with ovarian androgen excess: one with a normal birth weight distribution and with PCO, and one with lower birth weights and without PCO.

Objective: The present bibliometric study analyzes Spanish scientific work published in the field of obstetrics and gynecology in the most important journals during the period 1986-2002., Study Design: The material studied (779 original documents) was selected in accordance with the science citation index (SCI) of 2001, obstetrics and gynecology section, using the EMBASE: Obstetrics and Gynecology database. We applied the customary rules of bibliometrics: Price's Law of increase in scientific literature, Bradford's Law of scattering of scientific literature and Lotka's Law of author productivity. Furthermore, we analyzed participation index (PaI), the collaboration index and the superior (%SUP)., Results: The material studied is closer to an exponential adjustment (r = 0.958) than to a linear adjustment (r = 0.856). The journal with the largest number of originals is Human Reproduction (Bradford's first area), with 217 articles and that with the highest PaI is Menopause (4.07). The total number of authors is 1829, who are responsible for 3938 authorships (2.79% of the authors have a productivity index (PI) > or = 1 and 70.09% have a PI = 0). The majority of the studies were carried out in hospitals (47.62%) and universities (23.36%)., Conclusion: Spanish productivity in the field of obstetrics and gynecology increased considerably in the period 1986-2002.

CSF leaks in the ear are the result of an abnormal communication between subarachnoid and tympano mastoid areas, most of then as a result of trauma (90%). They mean a lisk of meningitis (4-50%) directly related to the etiology. Our aim is to present the CSF leak cases seen in our hospital in the last 2 years and a revision of their management. The main factor for a sucessful surgical repair is to use a multilayer tecnhique with a sucess rate close to 100%.

Uterine adenosarcoma is a mixed müllerian tumour consisting of a benign epithelial component and a malignant stromal component. It is a rare tumour that represents 8% of uterine sarcomas. We present a case of a 61-year-old woman who underwent a surgical hysteroscopy for postmenopausal metrorrhagia and thickened endometrium detected by ultrasonography. The pathologic diagnosis of the tumour removed by hysteroscopy was uterine adenosarcoma. The description of this case provides an opportunity to review the literature on uterine sarcomas diagnosed by surgical hysteroscopy.

This observational study evaluated the effect of a low-dose oral contraceptive (OC), containing 20 mug ethinylestradiol and 150 mug desogestrel (20EE/150DSG) on dysmenorrhea. Of the 346 women enrolled, 301 (87%) completed the three-cycle study. All participants (mean age: 22.6 years) wished to use oral contraception and had dysmenorrhea for at least 3 months. Dysmenorrhea was assessed using both the adapted verbal multidimensional scoring system (VMSS-A) and a visual analogue scale (VAS) to rate pain intensity. General dysmenorrhea symptoms and the use of analgesics were also assessed. The mean total combined scores on the VMSS-A scale decreased from 5.4 to 1.4 (p < 0.001), during the three cycles of OC use. The mean VAS pain-intensity score decreased from 6.8 to 1.8 (p < 0.001). During treatment there were substantial improvements in most individual parameters of dysmenorrhea. The percentage of women with dysmenorrhea lasting > or =2 days decreased from 81% at baseline to 14% at cycle 3. The percentage of women reporting generalized dysmenorrhea symptoms (e.g., lumbago, asthenia) decreased from 79% to 21% and the percentage needing analgesics dropped from 100% to 41%. The percentage of women for whom dysmenorrhea interfered with daily activities decreased from 73% to 10%. The results indicate that 20EE/150DSG can statistically and clinically significantly reduce the incidence and severity of dysmenorrhea, and its impact on daily activities.

Objective: To evaluate the role of inhibin in elevated base levels of FSH and follicular hyperplasia in ovarian autotransplantation in rats., Design: Experimental animal study., Setting: Unit of Experimental Research at the Barcelona University School of Medicine., Animal(s): Female syngeneic Lewis rats aged 16 weeks., Intervention(s): The animals were randomized into two groups: group A, control group undergoing only laparotomy (n = 5) and group B, oophorectomized with SC autologous heterotopic transplant (n = 5). The animals were killed and their ovaries removed for histologic, morphometric, and immunohistochemical analysis at 28 days after surgery in both groups., Main Outcome Measure(s): Serum levels of E2 and FSH were determined on day 0 (the day of surgery or baseline) and days 4, 7, 14, 21, and 28. Morphometric analysis of ovarian structure for evaluation of antral follicles and their granulosa cell area and immunohistochemistry for inhibin staining were also done., Result(s): The endocrinological function recovered at 28 days, and the FSH levels for the transplant group were significantly higher than for the group with normoinsert ovary. Morphometric analysis showed that the mean granulosa cell area was greater in group B when compared with the control group. Immunohistochemistry revealed almost null inhibin staining of the stroma in transplanted ovarian tissue., Conclusion(s): Tissue damage brought on by ischemia in the transplant of nonvascularized ovaries may bring about an inhibin deficit in the ovarian stroma, which might explain the increased levels of FSH. These increased levels, in turn, would be responsible for the follicular hyperplasia seen in this tissue when it recovers its function.

Introduction: The lateral bulbar syndrome is a heterogeneous clinical condition. It is usually of vascular origin, due to a reduction in postero inferior cerebellar artery (PICA) and vertebral artery blood flow., Case Report: We studied two cases: a woman aged 59 years and a man of 49 years, who were admitted with Wallenberg s syndrome. The diagnosis was confirmed on magnetic resonance which showed an ischaemic lesion in the lateral bulbar region ipsilateral to the clinical signs. On angioresonance there was lack of filling of the vertebral artery involved, and the PICA was not seen., Conclusions: At the present time, the most sensitive technique available for the diagnosis of the lateral bulbar syndrome is cranial magnetic resonance (it even appears to be useful for making aetiopathogenic hypotheses). Similarly, arteriography is widely used for assessing disorders of the posterior cerebral circulation, although it is not without risk. According to recent studies, angioresonance gives sensitivity and specificity of over 75% when used to assess anomalies of the vertebral and basilar arteries. So our observations corroborate the finding that angioresonance is a very sensitive, specific investigation for showing disorders of the vertebral arteries and PICA, which spares patients the morbidity associated with conventional arteriography.

The transplantation of ovarian tissue has recently been the focus of intense investigation with the aim of avoiding premature ovarian failure mainly in patients receiving chemotherapy or radiotherapy for malignant disease. Here, we present an evaluation of the long-term function of both fresh (patients 1, 2, and 3) and cryopreserved (patient 4) ovarian autografts in four premenopausal patients aged 46-49 yr who underwent heterotopic ovarian transplantation and were followed over a 1-yr period without receiving gonadotropins to stimulate follicular growth. In patients 1 and 2, approximately 1 cm(3) ovarian cortical autograft was placed sc in the inner aspect of the arm, whereas and in patients 3 and 4 minced ovarian tissue was placed into a muscle pocket in the abdominal wall. In patients 1, 2, and 4 the ovarian hormone secretion (as suggested by sequential estradiol and FSH serum measurements) was reestablished 3-4 months after autotransplantation, and graft function was not improved by immediate rather than delayed heterotopic ovarian autografting. Despite a reestablished ovarian function, a 2- to 7-fold increase in peripheral FSH concentration was evidenced. The cases reported here suggest that hormonal protection can be restored after fresh or cryopreserved heterotopic ovarian transplantation in women, albeit for only a short reproductive span.

We report a case of a 32-year-old woman who developed paroxysmal episodes of right hemidystonia 2 days after taking fluoxetine. The attacks subsided 2 days after fluoxetine was withdrawn and did not recur afterwards. To our knowledge, this is the first report of paroxysmal dystonia induced by fluoxetine., (Copyright 2001 Movement Disorder Society.)

Objective: To estimate the documented immunization coverage and degree to which schoolchildren's vaccination cards are kept up to date., Methods: Transversal descriptive study of children in the second year of primary education in the province of Valladolid during the 1999-2000 academic year. The sample consisted of 698 children with a participation rate of 82%. The percentage of children whose immunization schedule was up to date in accordance with their age, that of children with additional vaccinations and the accuracy of the vaccination cards was quantified. Information was collected through a questionnaire on vaccination cards or, for children without one, from their medical history., Results: The documented immunization coverage was 99.3% (95% CI: 98.6-99.9) for the first three dose of diphtheria toxoid, tetanus toxoid and pertussis vaccine and poliomyelitis vaccine, 98.9% (95% CI: 97.7-99.5) for the measles, mumps and rubella vaccine and 95% (95% CI: 93.4-96.7) for all doses up to the age of six. In addition, 7.2% (95% CI: 5.3-9.2) were immunized against hepatitis B, 14.4% (95% CI: 11.6-17) against Haemophilus influenzae type B and 90.3% (95% CI: 88-92.5) against meningococal A + C. A total of 84.4% of vaccination cards were correctly filled in (95% CI: 81.7-87.2)., Conclusions: Systematic immunization coverage in the schoolchildren was high. Because of their accuracy, vaccination cards were a useful tool for determining immunization coverage. Both the accuracy of the vaccination card and the incidence of non-systematic immunization were higher in urban areas.