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Johnson L, Saidu R, Mbulawa Z, Williamson A, Boa R, Tergas A, Moodley J, Svanholm-Barrie C, Persing D, Campbell S, Denny L, Kuhn L. Selecting HPV genotypes to optimize performance of GeneXpert and linear array in South Africa. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kuhn L, Svanholm-Barrie C, Saidu R, Tergas A, Boa R, Moodley J, Campbell S, Persing D, Denny L. Cancer biomarkers to improve performance of Xpert HPV for cervical cancer screening. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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3
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Guzha BT, Ngxola N, Adams T, Rogers L, Mbatani N, Wu HT, Fakie N, Muzenda V, Denny LA. Synchronous oligometastases in cervical cancer: a case report. Southern African Journal of Gynaecological Oncology 2018. [DOI: 10.1080/20742835.2018.1491139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- BT Guzha
- Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
- South African Medical Research Council (SAMRC)/University of Cape Town (UCT) Gynaecological Cancer Research Centre, Cape Town, South Africa
| | - N Ngxola
- Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
- South African Medical Research Council (SAMRC)/University of Cape Town (UCT) Gynaecological Cancer Research Centre, Cape Town, South Africa
| | - T Adams
- Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
- South African Medical Research Council (SAMRC)/University of Cape Town (UCT) Gynaecological Cancer Research Centre, Cape Town, South Africa
| | - L Rogers
- Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
- South African Medical Research Council (SAMRC)/University of Cape Town (UCT) Gynaecological Cancer Research Centre, Cape Town, South Africa
| | - N Mbatani
- Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
- South African Medical Research Council (SAMRC)/University of Cape Town (UCT) Gynaecological Cancer Research Centre, Cape Town, South Africa
| | - H-T Wu
- South African Medical Research Council (SAMRC)/University of Cape Town (UCT) Gynaecological Cancer Research Centre, Cape Town, South Africa
- Division of Anatomical Pathology, Groote Schuur Hospital, National Health Laboratory Service, Cape Town, South Africa
| | - N Fakie
- South African Medical Research Council (SAMRC)/University of Cape Town (UCT) Gynaecological Cancer Research Centre, Cape Town, South Africa
- Department of Radiation Oncology, Groote Schuur Hospital, Cape Town, South Africa
| | - V Muzenda
- Department of Radiology, Groote Schuur Hospital, Cape Town, South Africa
| | - LA Denny
- Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
- South African Medical Research Council (SAMRC)/University of Cape Town (UCT) Gynaecological Cancer Research Centre, Cape Town, South Africa
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Chuang L, Berek J, Randall T, McCormack M, Schmeler K, Manchanda R, Rebbeck T, Jeng C, Pyle D, Quinn M, Trimble E, Naik R, Lai C, Ochiai K, Denny L, Bhatla N. Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities. Gynecol Oncol Rep 2018; 25:65-69. [PMID: 29928684 PMCID: PMC6008286 DOI: 10.1016/j.gore.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 11/28/2022] Open
Abstract
Eighty-five percent of the incidents and deaths from cervical cancer occur in low and middle income countries. In many of these countries, this is the most common cancer in women. The survivals of the women with gynecologic cancers are hampered by the paucity of prevention, screening, treatment facilities and gynecologic oncology providers. Increasing efforts dedicated to improving education and research in these countries have been provided by international organizations. We describe here the existing educational and research programs that are offered by major international organizations, the barriers and opportunities provided by these collaborations and hope to improve the outcomes of cervical cancer through these efforts.
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Affiliation(s)
- L. Chuang
- Western Connecticut Health Network, Larner College of Medicine at the University of Vermont, Danbury, CT, USA
| | - J. Berek
- Stanford University School of Medicine, Stanford, CA, USA
| | - T. Randall
- The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - K. Schmeler
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R. Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - T. Rebbeck
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - C.J. Jeng
- Kaohsiung Medical University Hospital, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - D. Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - M. Quinn
- University of Melbourne, Melbourne, VIC, Australia
| | - E. Trimble
- Center for Global Health, National Cancer Institute, Bethesda, MS, USA
| | - R. Naik
- Northern Gynecological Oncology Centre, Gateshead, UK
| | - C.H. Lai
- Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - K. Ochiai
- Jikei University School of Medicine, Tokyo, Japan
| | - L. Denny
- University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa
| | - N. Bhatla
- All India Institute of Medical Sciences, New Delhi, India
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Denny LA. Cervical intraepithelial neoplasia. Southern African Journal of Gynaecological Oncology 2015. [DOI: 10.1080/20742835.2009.11441127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L A Denny
- Department Obstetrics and Gynaecology, Gynaecology Oncology Unit, University of Cape Town/Groote Schuur Hospital
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Prat J, Belhadj H, Berek J, Bermudez A, Bhatla N, Cain J, Denny L, Fujiwara K, Hacker N, Avall-Lundqvist E, Mutch D, Odicino F, Pecorelli S, Quinn M, Seoud MAF, Shrivastava SK. Abridged republication of FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum. EUR J GYNAECOL ONCOL 2015; 36:367-369. [PMID: 26390684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Arulkumaran S, Denny L, Cain J. Sicherheit von HPV-Impfungen: eine Erklärung der FIGO. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0033-1351076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - L. Denny
- Vorsitzende, FIGO Komitee für Gynäkologische Onkologie
| | - J. Cain
- Vorsitzende, Unterausschuss für Verhütung von Gebärmutterhalskrebs
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Denny L, Hendricks B, Gordon C, Hervé C, Thomas F, Hezareh M, Dobbelaere K, Durand C, Struyf F. O180 SAFETY AND IMMUNOGENICITY OF THE HPV-16/18 AS04-ADJUVANTED VACCINE IN HIV-POSITIVE WOMEN IN SOUTH AFRICA UP TO 12 MONTHS AFTER VACCINATION. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60610-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Rogers LJ, Wu H, Govender D, Denny LA. Case Study: Epithelioid sarcoma of the vulva. Southern African Journal of Gynaecological Oncology 2010. [DOI: 10.1080/20742835.2010.11441156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Denny L. I79 International federation of colposcopy and cervical pathology: Cervical cancer prevention across five continents - current successes and future challenges. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rogers L, Howard B, Van Wijk L, Wei W, Dehaeck K, Soeters R, Denny L. O805 Chemoradiation in advanced vulval carcinoma. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Denny L. I80 Is control of cervical cancer possible in the developing world? Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Denny L. I78 Cervical pathology in HIV positive women. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- J Cain
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, Oregon 97239, USA.
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Affiliation(s)
- L Denny
- Groote Schuur Hospital, Dept. of Gynaecological Oncology, H 45 OMB, Observatory, 7925 Cape Town, South Africa.
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Myer L, Kuhn L, Denny L, Wright TC. THE AUTHORS REPLY. Am J Epidemiol 2006. [DOI: 10.1093/aje/kwk102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tu JJ, Kuhn L, Denny L, Beattie KJ, Lorincz A, Wright TC. Molecular variants of human papillomavirus type 16 and risk for cervical neoplasia in South Africa. Int J Gynecol Cancer 2006; 16:736-42. [PMID: 16681754 DOI: 10.1111/j.1525-1438.2006.00401.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Non-European variants of human papillomavirus (HPV) type 16 are generally associated with a greater risk of cervical neoplasia than European prototype variants. We investigated whether this association would persist in a population in which non-European HPV 16 variants were more common. We sequenced HPV 16 isolates in cervical samples collected from 93 Black South African women enrolled in a cervical cancer screening study and examined associations between cervical neoplasia identified though colposcopy with cervical biopsy and the specific HPV 16 variant identified. The European prototype variant (EP) was the most commonly identified variant in this population (47% of all isolates), but African variants (Af-1 and Af-2) were also quite common (41% of all isolates). In contrast to previous studies, we found no evidence that non-European variants were associated with an increased risk of neoplasia. Rather, most of the HPV 16-associated cancers were found in association with EP (71% of 14 cases). In this setting where African HPV 16 variants were common, no increased risk for cervical neoplasia was found among women with these variants compared with other HPV 16 variants.
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Affiliation(s)
- J J Tu
- Department of Pathology, Weill Medical College of Cornell University, New York, New York, USA
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Abstract
Cervical cancer kills over a quarter of a million women worldwide on an annual basis, with 80% of these deaths occurring in developing countries. Cytology-based screening programs, widely used in industrialized countries, are difficult to implement in low-resource settings. Non-cytological methods for screening and treatment have been developed and studied over the last decade. Given the barriers to widespread, good quality screening and early treatment, the most promising new prevention strategy will be the introduction of a vaccine to prevent human papillomavirus infection, the cause of cervical cancer. Understanding women's health-seeking behaviors is critical to successful dissemination and uptake of both screening and vaccine prevention strategies.
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Affiliation(s)
- A E Pollack
- Mailman School of Public Health, Columbia University, New York, NY, USA.
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Abstract
Cervical cancer is a largely preventable disease through the detection, treatment and follow-up of its precursors. Traditionally, this has been accomplished through screening women with cervical cytology, and referring women with abnormal cytology for colposcopy, histological sampling and treatment. In organized programmes that achieve wide coverage of the target population at frequent intervals, this approach has resulted in a considerable reduction in cervical cancer. Recently, however, the development of reliable and reproducible tests for the detection of human papillomavirus (HPV) infection of the cervix (which is now accepted to be causally associated with the development of almost all cervical cancers) has led to the evaluation of HPV de-oxyribonucleic acid (DNA) testing as either an alternative or adjunctive test to cytology for the detection of cervical cancer and its precursors. There is now a large body of data supporting the clinical utility of HPV DNA testing for the prevention of cervical cancer, particularly in the settings of primary screening of women older than 30 years, in the triage of women with equivocal cytology and for the follow-up of women post-treatment.
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Affiliation(s)
- L A Denny
- Department of Obstetrics and Gynaecology, University of Cape Town, H45, Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa.
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Risi L, Bindman JP, Campbell OMR, Imrie J, Everett K, Bradley J, Denny L. Media interventions to increase cervical screening uptake in South Africa: an evaluation study of effectiveness. Health Educ Res 2004; 19:457-68. [PMID: 15155598 DOI: 10.1093/her/cyg044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Successful cervical cancer prevention depends on reaching, screening and treating women with pre-invasive disease. We aimed to evaluate the effectiveness of two media interventions-a photo-comic and a radio-drama-in increasing cervical screening uptake. A randomized controlled trial compared a photo-comic on cervical cancer screening with a placebo comic. One month after the comics were distributed a radio-drama paralleling the photo-comic was broadcast on the community radio station and a retrospective evaluation was carried out. The trial was set in Khayelitsha, a peri-urban squatter community near Cape Town, South Africa. A random sample consisted of 658 women between the ages of 35 and 65 years, from a stratified sample of census areas. The main outcome measure was self-reported cervical screening uptake 6 months after distribution of the comics. Seven percent (18 of 269) of women who received the intervention photo-comic reported cervical screening during the 6 months follow-up, compared with 6% (25 of 389) of controls (P = 0.89). Women who recalled hearing the radio-drama were more likely to report attending screening (nine of 53, 17%) than those who did not (19 of 429, 4%; P < 0.001). We conclude that the photo-comic was ineffective in increasing cervical screening uptake in this population. The radio-drama may have had more impact, but only a minority of women recalled being exposed to it. Future research must concentrate not only on achieving high level of exposure to health messages, but also on investigating the links between exposure and action.
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Affiliation(s)
- L Risi
- Lewisham VTS, SLOVTS, Gassiot House, St Thomas's Hospital, London SE1 7EH, UK
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Semple PL, Denny L, Coughlan M, Soeters R, Van Wijk L. The role of neurosurgery in the treatment of cerebral metastases from choriocarcinoma: a report of two cases. Int J Gynecol Cancer 2004. [DOI: 10.1136/ijgc-00009577-200401000-00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cerebral metastases from choriocarcinoma are a poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. However, with the increased experience with chemotherapy and radiotherapy the prognosis of this group of patients has improved substantially. Neurosurgery remains an option for selected patients. We present two patients who underwent craniotomy as part of their management of choriocarcinoma, and review the role of neurosurgery in the treatment of gestational trophoblastic disease.
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Semple PL, Denny L, Coughlan M, Soeters R, Van Wijk L. The role of neurosurgery in the treatment of cerebral metastases from choriocarcinoma: a report of two cases. Int J Gynecol Cancer 2004; 14:157-61. [PMID: 14764045 DOI: 10.1111/j.1048-891x.2004.14147.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cerebral metastases from choriocarcinoma are a poor prognostic indicator of outcome in both the World Health Organization and FIGO classification systems. However, with the increased experience with chemotherapy and radiotherapy the prognosis of this group of patients has improved substantially. Neurosurgery remains an option for selected patients. We present two patients who underwent craniotomy as part of their management of choriocarcinoma, and review the role of neurosurgery in the treatment of gestational trophoblastic disease.
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Affiliation(s)
- P L Semple
- Department of Neurosurgery, Groote Schuur Hospital, University of Cape Town, South Africa
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Hoffman M, Cooper D, Carrara H, Rosenberg L, Kelly J, Stander I, Williamson AL, Denny L, du Toit G, Shapiro S. Limited Pap screening associated with reduced risk of cervical cancer in South Africa. Int J Epidemiol 2003; 32:573-7. [PMID: 12913031 DOI: 10.1093/ije/dyg081] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigated the effect of Pap smear screening on the incidence of invasive cancer of the cervix in the Western Cape, South Africa where screening is limited. METHODS Data were derived from a case-control study of the association of hormonal contraceptives and invasive cervical cancer. Incident cases (n = 524) of invasive cervical cancer who presented at two tertiary hospitals and controls (n = 1540) series matched for age, race, and place of residence were interviewed. Information on a wide range of variables was collected including whether the women had previously had a Pap smear taken and the number and timing of smears. Odds ratios (OR) and 95% CI were calculated using multiple logistic regression. RESULTS The OR of cervical cancer was reduced among women who had ever had a smear (OR = 0.3, 95% CI: 0.3-0.4). The OR declined with increasing number of smears to 0.2 for >/=>3 smears (trend P = 0.0003). Among women who had a smear <5 years previously the OR was 0.3, but even if the smear was taken >/=15 years previously the women remained at reduced risk (OR = 0.5). CONCLUSION The data suggest that even limited Pap smear screening reduces the risk of cervical cancer. Should a screening programme be successfully implemented, the incidence of cervical cancer might be reduced by as much as 70%.
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Affiliation(s)
- M Hoffman
- Department of Public Health and Primary Health Care, University of Cape Town, South Africa.
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Marais DJ, Best JM, Rose RC, Keating P, Soeters R, Denny L, Dehaeck CM, Nevin J, Kay P, Passmore JA, Williamson AL. Oral antibodies to human papillomavirus type 16 in women with cervical neoplasia. J Med Virol 2001; 65:149-54. [PMID: 11505457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This study investigated the relationship between human papillomavirus type 16 (HPV-16) antibodies detected in oral fluid from women with cervical neoplasia, their HPV-16 antibody seroprevalence, and their cervical HPV-16 DNA presence. Cervical HPV-16 DNA was detected by polymerase chain reaction in 43.2% (35/81) of these women. The prevalence of IgG and IgA antibodies to HPV-16 virus-like particles (VLP-16) in oral fluid and was investigated by enzyme-linked immunosorbent assay. Anti-VLP-16 IgA antibodies were detected in oral fluid from 54.3% (44/81) of women with cervical neoplasia, compared with 8% (3/36) in controls (P = 0.000002). Anti-VLP-16 IgG was detected in oral fluid from 43.2.9% (25/72) and 13.3% (4/30; P = 0.029), respectively. Women who were HPV-16 DNA positive at their cervical lesion, displayed an oral fluid anti-VLP-16 IgA prevalence of 60.7% (17/28) and HPV-16 DNA negative women an oral fluid anti-VLP-16 IgA prevalence of 50% (20/40; P = 0.38). Oral fluid anti-VLP-16 IgG prevalence in HPV-16 DNA positive women was 28.6% (8/28) compared with 40% (16/40) in oral fluid from HPV-16 DNA negative women (P = 0.3). Amongst HPV-16 DNA positive women, the anti-VLP-16 IgG seroprevalence was 75% (21/28) and IgA seroprevalence 35.7% (10/28) and for the HPV-16 DNA negative women these values were 60% (24/40) and 32.5% (13/40), respectively. Oral IgA antibody testing proved no more sensitive than serum antibody detection for the determination of HPV infection but could be useful as a non-invasive screening method for women with cervical neoplasia and for estimating the mucosal antibody response to HPV vaccines.
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Affiliation(s)
- D J Marais
- University of Cape Town, Division of Medical Virology, Department of Laboratory Medicine, Faculty of Health Sciences, Observatory, Cape Town, South Africa
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Goldie SJ, Kuhn L, Denny L, Pollack A, Wright TC. Policy analysis of cervical cancer screening strategies in low-resource settings: clinical benefits and cost-effectiveness. JAMA 2001; 285:3107-15. [PMID: 11427139 DOI: 10.1001/jama.285.24.3107] [Citation(s) in RCA: 236] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Cervical cancer is a leading cause of cancer-related death among women in developing countries. In such low-resource settings, cytology-based screening is difficult to implement, and less complex strategies may offer additional options. OBJECTIVE To assess the cost-effectiveness of several cervical cancer screening strategies using population-specific data. DESIGN AND SETTING Cost-effectiveness analysis using a mathematical model and a hypothetical cohort of previously unscreened 30-year-old black South African women. Screening tests included direct visual inspection (DVI) of the cervix, cytologic methods, and testing for high-risk types of human papillomavirus (HPV) DNA. Strategies differed by number of clinical visits, screening frequency, and response to a positive test result. Data sources included a South African screening study, national surveys and fee schedules, and published literature. MAIN OUTCOME MEASURES Years of life saved (YLS), lifetime costs in US dollars, and incremental cost-effectiveness ratios (cost per YLS). RESULTS When analyzing all strategies performed as a single lifetime screen at age 35 years compared with no screening, HPV testing followed by treatment of screen-positive women at a second visit, cost $39/YLS (27% cancer incidence reduction); DVI, coupled with immediate treatment of screen-positive women at the first visit was next most effective (26% cancer incidence reduction) and was cost saving; cytology, followed by treatment of screen-positive women at a second visit was least effective (19% cancer incidence reduction) at a cost of $81/YLS. For any given screening frequency, when strategies were compared incrementally, HPV DNA testing generally was more effective but also more costly than DVI, and always was more effective and less costly than cytology. When comparing all strategies simultaneously across screening frequencies, DVI was the nondominated strategy up to a frequency of every 3 years (incremental cost-effectiveness ratio, $460/YLS), and HPV testing every 3 years (incremental cost-effectiveness ratio, $11 500/YLS) was the most effective strategy. CONCLUSION Cervical cancer screening strategies that incorporate DVI or HPV DNA testing and eliminate colposcopy may offer attractive alternatives to cytology-based screening programs in low-resource settings.
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Affiliation(s)
- S J Goldie
- Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Ave, Suite 2, Boston, MA 02115-5924, USA.
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Wright T, Denny L, Kuhn L, Pollack A, Lorincz A. HPV DNA Testing of Self-Collected Vaginal Samples Compared With Cytologic Screening To Detect Cervical Cancer. J Low Genit Tract Dis 2001. [DOI: 10.1046/j.1526-0976.2001.51012-4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Noncytologic methods of screening for cervical carcinoma and its precursor lesions are needed for resource-poor settings in which cervical carcinoma continues to be an important cause of morbidity and mortality. METHODS Two thousand nine hundred forty-four women ages 35-65 years were recruited from Cape Town, South Africa and screened using a combination of a Papanicolaou (Pap) smear, human papillomavirus (HPV) DNA testing, direct visual inspection after the application of a 5% acetic acid solution (DVI), and cervicography. Cervicography was considered primarily as a method with which to quality control the DVI examinations. Women with squamous intraepithelial lesions (SIL) or carcinoma on Pap smear, positive DVI examination (acetowhite lesion or cervical ulcer/growth), high levels of high risk HPV DNA (relative light units [RLU] > 10x positive control), or positive Cervigramtrade mark were referred for colposcopy and cervical biopsy. RESULTS Pap smears were positive in 8.1% of all women screened and identified 65 (78%) of all cases of biopsy confirmed high grade disease (high grade SIL or invasive carcinoma). DVI and cervicography were classified as positive in 18.1% and 10.5%, respectively, of women screened and identified 58 (67%) and 46 (58%) of all cases of high grade disease, respectively. The results of HPV DNA testing varied depending on the cutoff value used to define a positive result. At the standard cutoff level (RLU > 1x positive control), 16.2% of women screened were classified as high risk HPV DNA positive, as were 63 women with high grade disease (73%). CONCLUSIONS DVI and HPV DNA testing identified similar numbers of high grade SIL (cervical intraepithelial neoplasia Grade 2,3) and invasive carcinoma cases as Pap smears. However, both classify considerably more women without cervical disease as being test positive.
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Affiliation(s)
- L Denny
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
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Abstract
BACKGROUND Noncytologic methods of screening for cervical carcinoma and its precursor lesions are needed for resource-poor settings in which cervical carcinoma continues to be an important cause of morbidity and mortality. METHODS Two thousand nine hundred forty-four women ages 35-65 years were recruited from Cape Town, South Africa and screened using a combination of a Papanicolaou (Pap) smear, human papillomavirus (HPV) DNA testing, direct visual inspection after the application of a 5% acetic acid solution (DVI), and cervicography. Cervicography was considered primarily as a method with which to quality control the DVI examinations. Women with squamous intraepithelial lesions (SIL) or carcinoma on Pap smear, positive DVI examination (acetowhite lesion or cervical ulcer/growth), high levels of high risk HPV DNA (relative light units [RLU] > 10x positive control), or positive Cervigramtrade mark were referred for colposcopy and cervical biopsy. RESULTS Pap smears were positive in 8.1% of all women screened and identified 65 (78%) of all cases of biopsy confirmed high grade disease (high grade SIL or invasive carcinoma). DVI and cervicography were classified as positive in 18.1% and 10.5%, respectively, of women screened and identified 58 (67%) and 46 (58%) of all cases of high grade disease, respectively. The results of HPV DNA testing varied depending on the cutoff value used to define a positive result. At the standard cutoff level (RLU > 1x positive control), 16.2% of women screened were classified as high risk HPV DNA positive, as were 63 women with high grade disease (73%). CONCLUSIONS DVI and HPV DNA testing identified similar numbers of high grade SIL (cervical intraepithelial neoplasia Grade 2,3) and invasive carcinoma cases as Pap smears. However, both classify considerably more women without cervical disease as being test positive.
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Affiliation(s)
- L Denny
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
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Abstract
BACKGROUND Noncytologic methods of screening for cervical carcinoma and its precursor lesions are needed for resource-poor settings in which cervical carcinoma continues to be an important cause of morbidity and mortality. METHODS Two thousand nine hundred forty-four women ages 35-65 years were recruited from Cape Town, South Africa and screened using a combination of a Papanicolaou (Pap) smear, human papillomavirus (HPV) DNA testing, direct visual inspection after the application of a 5% acetic acid solution (DVI), and cervicography. Cervicography was considered primarily as a method with which to quality control the DVI examinations. Women with squamous intraepithelial lesions (SIL) or carcinoma on Pap smear, positive DVI examination (acetowhite lesion or cervical ulcer/growth), high levels of high risk HPV DNA (relative light units [RLU] > 10x positive control), or positive Cervigramtrade mark were referred for colposcopy and cervical biopsy. RESULTS Pap smears were positive in 8.1% of all women screened and identified 65 (78%) of all cases of biopsy confirmed high grade disease (high grade SIL or invasive carcinoma). DVI and cervicography were classified as positive in 18.1% and 10.5%, respectively, of women screened and identified 58 (67%) and 46 (58%) of all cases of high grade disease, respectively. The results of HPV DNA testing varied depending on the cutoff value used to define a positive result. At the standard cutoff level (RLU > 1x positive control), 16.2% of women screened were classified as high risk HPV DNA positive, as were 63 women with high grade disease (73%). CONCLUSIONS DVI and HPV DNA testing identified similar numbers of high grade SIL (cervical intraepithelial neoplasia Grade 2,3) and invasive carcinoma cases as Pap smears. However, both classify considerably more women without cervical disease as being test positive.
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Affiliation(s)
- L Denny
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
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Denny L, Kuhn L, Risi L, Richart RM, Pollack A, Lorincz A, Kostecki F, Wright TC. Two-stage cervical cancer screening: an alternative for resource-poor settings. Am J Obstet Gynecol 2000; 183:383-8. [PMID: 10942474 DOI: 10.1067/mob.2000.105871] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to introduce 2-stage cervical cancer screening in which 2 screening tests are performed sequentially (the second test is performed only if the first result is positive), followed by treatment if both test results are abnormal. STUDY DESIGN A total of 1423 women from Cape Town, South Africa, were screened by direct visual inspection, human papillomavirus deoxyribonucleic acid testing, cytologic testing, and cervicography. If an abnormality was identified with any test, women were referred for colposcopy. RESULTS Direct visual inspection, cytologic testing, human papillomavirus deoxyribonucleic acid testing, and cervicography, when used alone, identified 24, 26, 23, and 23 cases of disease (high-grade squamous intraepithelial lesion or cancer) per 1000 women, respectively, and would classify 182, 71, 137, and 112 women without disease as having abnormal results. Two-stage screening with direct visual inspection first, followed by cytologic testing, human papillomavirus deoxyribonucleic acid testing, or cervicography, would detect 18, 16, and 18 cases per 1000 women, respectively, and would substantially reduce the number of women without disease who were classified as having abnormal results. CONCLUSION Two-stage screening for cervical cancer provides an attractive alternative to conventional screening for low-resource settings.
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Affiliation(s)
- L Denny
- Department of Obstetrics and Gynecology, University of Cape Town, South Africa
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31
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Kuhn L, Denny L, Pollack A, Lorincz A, Richart RM, Wright TC. Human papillomavirus DNA testing for cervical cancer screening in low-resource settings. J Natl Cancer Inst 2000; 92:818-25. [PMID: 10814677 DOI: 10.1093/jnci/92.10.818] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In many low-resource settings, there are barriers to cytologic screening for cervical cancer. This study evaluates human papillomavirus (HPV) DNA testing as an alternative screening method. METHODS Cervical samples from 2944 previously unscreened South African women aged 35-65 years were tested for high-risk types of HPV with the use of the Hybrid Capture I (HCI) assay. Women also had a Pap smear, direct visual inspection of the cervix, and Cervicography(TM). Women positive on any screening test were referred for colposcopy. Samples from women with biopsy-confirmed, low-grade squamous intraepithelial lesions (SILs) (n = 95), high-grade SILs (n = 74), or invasive cervical cancer (n = 12) and a random sample of women with no cervical disease (n = 243) were retested for HPV DNA with the use of the more sensitive Hybrid Capture II (HCII) assay. All P values are two-sided. RESULTS High-risk HPV DNA was detected in 73.3% and 88.4% of 86 women with high-grade SIL or invasive cancer and in 12.2% of 2680 and 18.1% of 243 women without evidence of cervical disease, with the use of the HCI and HCII assays, respectively. HPV DNA testing with the HCII assay was more sensitive than cytology for detecting high-grade SIL and invasive cancer (McNemar's test, P =.04), and testing with the HCI assay was of equivalent sensitivity (P =.61). Cytology had a statistically significantly better specificity (96.8%) than either the HCI assay (87.8%) or the HCII assay (81.9%) (P<.01). Receiver operating characteristic curves identified test cutoff values that allow HPV DNA testing to identify 57% of women with high-grade SIL or cancer, while classifying less than 5% of women with no cervical disease as HPV DNA positive. CONCLUSIONS HPV DNA testing has a sensitivity equivalent to, or better than, that of cytology. Since HPV DNA testing programs may be easier to implement than cytologic screening, HPV testing should be considered for primary cervical cancer screening in low-resource settings.
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Affiliation(s)
- L Kuhn
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Division of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Marais DJ, Rose RC, Lane C, Kay P, Nevin J, Denny L, Soeters R, Dehaeck CM, Williamson AL. Seroresponses to human papillomavirus types 16, 18, 31, 33, and 45 virus-like particles in South African women with cervical cancer and cervical intraepithelial neoplasia. J Med Virol 2000; 60:403-10. [PMID: 10686023 DOI: 10.1002/(sici)1096-9071(200004)60:4<403::aid-jmv7>3.0.co;2-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of the study was to determine the prevalence of antibodies to human papillomavirus (HPV) types 16, 18, 31, 33, and 45 in woman in Cape Town with cervical intraepithelial neoplasia (CIN) (n = 95), cervical cancer (n = 40), female blood donors (n = 95) and children (n = 110). The enzyme-linked immunosorbent assay (ELISA) made use of baculovirus synthesised HPV virus like particles (VLPs) as antigen. Antibodies to at least one HPV type were detected in sera from 75% of cancer patients, 71.6% of CIN patients, 44.2% of blood donors and 27.3% of children. Sera from 95 women with CIN were compared with age-matched female blood donors. There was a significant association of seropositivity to VLP-16 (P = 0.006) and VLP-45 (P = 0.008) with CIN compared with the blood donors. There was also a significant difference in the seropositivity of women with CIN to any of the five virus-like particle (VLP) types compared to the blood donors (P = 0.0002: OR = 3.2). Thirty-nine of sixty-nine (56.5%) women with CIN were found to be HPV-16 DNA positive. The average age of women in this group that were VLP-16 seropositive was 34 years and those found to be VLP-16 seronegative was 52 years of age. Antibodies to all five VLP types were detected in these populations, thus an ideal vaccine should induce protection from infection by a wide range of HPV types.
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Affiliation(s)
- D J Marais
- Department of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa
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Abstract
CONTEXT More than half of the women diagnosed as having cervical cancer in the United States have not been screened within the last 3 years, despite many having had contact with the health care system. In many other regions of the world, there is only limited access to cervical cancer screening. OBJECTIVE To determine whether testing of self-collected vaginal swabs for human papillomavirus (HPV) DNA can be used to screen for cervical disease in women aged 35 years and older. DESIGN Cross-sectional observational study comparing Papanicolaou smears with HPV DNA testing of self-collected vaginal swabs. SETTING Outpatient clinics in a periurban settlement outside of Cape Town, South Africa, between January 1998 and April 1999. PARTICIPANTS Screening was performed on 1415 previously unscreened black South African women aged 35 to 65 years. INTERVENTION Women self-collected a vaginal swab for HPV testing in the clinic and were then screened using 4 different tests: Papanicolaou smear, direct visual inspection of the cervix after the application of 5% acetic acid, cervicography, and HPV DNA testing of a clinician-obtained cervical sample. Women with abnormal results on any of the screening tests were referred for colposcopy. MAIN OUTCOME MEASURE Biopsy-confirmed high-grade cervical squamous intraepithelial lesions or invasive cancer. RESULTS High-grade squamous intraepithelial lesions were identified in 47 (3.4%) of 1365 women adequately assessed, and there were 9 cases of invasive cancer. Of women with high-grade disease, 66.1% (95% confidence interval [CI], 52.1%-77.8%) had high risk for HPV detected in self-collected vaginal samples, and 67.9% (95% CI, 53.9%-79.4%) had an abnormal Papanicolaou smear (P = .78). The false-positive rates for HPV DNA testing of self-collected vaginal samples and Papanicolaou smears were 17.1% (95% CI, 15.1%-19.3%) and 12.3% (95% CI, 10.5%-14.2%), respectively (P<.001). A high-risk type of HPV DNA was detected in 83.9% (95% CI, 71.2%-91.9%) of women with high-grade disease and 15.5% (95% CI, 13.6%-17.7%) of women with no evidence of cervical disease using a clinician-obtained cervical sample. CONCLUSIONS These results indicate that HPV testing of self-collected vaginal swabs is less specific than but as sensitive as Papanicolaou smears for detecting high-grade cervical disease in women aged 35 years and older, and HPV testing offers an important new way to increase screening in settings where cytology is not readily performed.
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Affiliation(s)
- T C Wright
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Wilder-Smith CH, Hill L, Wilkins J, Denny L. Effects of morphine and tramadol on somatic and visceral sensory function and gastrointestinal motility after abdominal surgery. Anesthesiology 1999; 91:639-47. [PMID: 10485772 DOI: 10.1097/00000542-199909000-00013] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic nociceptive input induces sensitization and changes in regulatory reflexes in animal models. In humans, postoperative somatic and visceral sensitization and the secondary effects on reflex gut motility are unclear. METHODS Somatic and visceral sensation and gastrointestinal motility were evaluated after abdominal hysterectomies in 50 patients who were randomized to receive double-blinded postoperative 48-h infusions of morphine or tramadol. Pain scores, rectal distension, skin electric sensation and pain tolerance thresholds, and gastrointestinal transit were assessed before and after operation, during and after analgesic infusions. RESULTS Pain intensity scores decreased similarly with morphine and tramadol infusions (total doses, 66.8+/-20 mg and 732.4+/-152 mg [mean +/- SD], respectively). Skin pain tolerance thresholds in the incisional dermatome remained similar with morphine and tramadol throughout the study. During morphine infusions, pain tolerance thresholds on the shoulder increased (P<0.05) and then decreased after discontinuation on day 4 (P<0.02) compared with before operation. Rectal distension pain tolerance pressure thresholds increased after operation during morphine infusions (P<0.05). Similar but nonsignificant trends occurred with tramadol. Orocecal and colonic transit times increased after operation with both morphine and tramadol (P<0.005), but gastric emptying was prolonged only with morphine (P = 0.03). AU motility and sensory parameters had returned to preoperative levels by 1 month after operation. CONCLUSIONS Pain control was equally effective with morphine and tramadol infusions. No somatic or visceral sensitization was evident during morphine and tramadol infusions, but pain tolerance thresholds as markers of antinociception were increased more during morphine infusions. The significant sensitization seen only after morphine discontinuation may be due to convergent visceral input. Gut motility was prolonged significantly by visceral surgery itself and also by morphine.
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Affiliation(s)
- C H Wilder-Smith
- Visceral Physiology Institute, Department of Pharmacology, Groote Schuur Hospital, University of Cape Town, South Africa.
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Abstract
Associations between Depo-Provera (injectable, progesterone-only contraceptive) use and visible disruption of cervical epithelium and cervical ectopy were investigated using data collected as part of a cervical cancer screening study in periurban Cape Town, South Africa. Women were interviewed about their contraceptive use, and underwent a gynecologic examination that included two 35-mm photographs of the cervix after application of 5% acetic acid. Photographs of 723 subjects were reviewed (blind to clinical information and using systematic criteria developed before review) for evidence of atrophy and epithelial disruption, including inflammation and ulceration. The percentage of the cervix covered with columnar epithelium (ectopy) was also estimated from the photographs. A random sample of 85 photographs was reviewed again for reliability. A total of 121 current users of Depo-Provera were no more likely to have evidence of epithelial disruption (38%) than 574 nonusers (39%), odds ratio (OR) = 1.37, 95% CI: 0.89-2.11 adjusting for age and parity. The prevalence of significant ectopy (columnar epithelium covering > 10% of the cervix) was also no different among current Depo-Provera users (OR = 1.22, 95% CI: 0.80-1.86 adjusting for age and parity). Reliability of visual scoring of epithelial disruption and ectopy was excellent (kappa = 0.8). Although the underlying prevalence of visible disruption of cervical epithelium was very high, current use of Depo-Provera was not associated with increased prevalence of visible disruption of the cervical epithelium or with ectopy in this sample of African women.
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Affiliation(s)
- L Kuhn
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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36
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Affiliation(s)
- J Nevin
- Gynaecological Oncology Unit, University of Cape Town/Groote Schuur Hospital, South Africa
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37
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Nevin J, Denny L, Dehaeck K, van Wijk L, Keating P, Soeters R. Hormone replacement therapy--1997. S Afr Med J 1997; 87:1552. [PMID: 9472283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Bloch B, Denny L, Nevin J, Dehaeck K, Whittaker J, Soeters R. Cytological screening for cervical cancer--what are its opportunity costs? S Afr Med J 1997; 87:615; author reply 615, 618. [PMID: 9254827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Abstract
OBJECTIVE To investigate the value of acetic acid visualization of the cervix as an alternative to cytologic screening. METHODS A prospective study was conducted in a squatter area in Cape Town, South Africa, on 2426 women who underwent speculum examination, naked-eye inspection of the cervix after application of acetic acid, and cytologic smear. The smears were stained and processed at the screening site. Patients with a positive reading after acetic acid or a smear indicating a high-grade squamous intraepithelial lesion (SIL) were referred for immediate colposcopy, biopsy, and when indicated, treatment by large loop excision of the transformation zone. Therefore, histology was obtained on all patients with a positive acetic acid test or a positive cytology. RESULTS Seventy-six women with positive reactions to acetic acid. Among the 2350 women with negative reactions, 254 had positive cervical smears; only 11 of these had histologic high-grade SIL. In contrast, 20 of the 61 women with positive cytology and positive acetic acid test had high-grade SIL on histology. Therefore, the acetic acid reaction enabled the observer to detect 20 of the 31 women (64%) who exhibited a high-grade SIL both on cytology and histology. CONCLUSION In locations where access to cytopathology is limited, naked-eye visualization of the cervix after application of diluted acetic acid warrants consideration as an alternative in the detection of cervical premalignant lesions.
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Affiliation(s)
- E Megevand
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, Republic of South Africa
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40
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Dehaeck K, Denny L, Thomas C, Dommisse J, Anthony J, Nevin J, Fawcus S, Robinson J, Bloch B, Kent A, Wright M, Largier D, Stewart C, de Jong P, van Coverden de Groot HA, Smith P, Ackovic K, Rossouw B, Alperstein A, Tsalacopoulos G, Roos P, Dhansay R, Esterhuizen M, Bonellie G, Soeters R. Patient sedation for routine genital examination. S Afr Med J 1996; 86:973. [PMID: 8823425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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41
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Whittaker J, Cruse P, Denny L, Dehaeck K, Soeters R, Duffield M, Bloch B, Wranz P, MacCallum S. PAPNET automated screening. S Afr Med J 1996; 86:273-4. [PMID: 8658306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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42
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Denny LA, Dehaeck K, Nevin J, Soeters R, van Wijk AL, Megevand E, Bloch B. Placental site trophoblastic tumor: three case reports and literature review. Gynecol Oncol 1995; 59:300-3. [PMID: 7590491 DOI: 10.1006/gyno.1995.0026] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The clinical features of three patients with placental site trophoblastic tumour (PSTT) are presented. Two patients had probable nephrotic syndrome, which was unrecognized at the time. The nephrotic syndrome disappeared after hysterectomy in one patient and the other demised after one cycle of chemotherapy. The use of hysteroscopy in one patient and the management of a pulmonary metastasis in another are described.
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Affiliation(s)
- L A Denny
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, Cape Town, South Africa
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Anthony J, Coetzee EJ, Kent AP, van der Spuy ZM, Denny LA, Stewart CJ, de Jong PR, van Coeverden de Groot HA. HIV in pregnancy--a policy needed. S Afr Med J 1995; 85:936. [PMID: 8545769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Abstract
OBJECTIVE To evaluate the role of punch biopsy in reducing the occurrence of negative histology provided by large loop excision of the transformation zone in the management of cervical intraepithelial neoplasia. DESIGN Retrospective review of computerised data base and clinic files. SETTING Colposcopy Clinic, Groote Schuur Hospital, Cape Town, South Africa. SUBJECTS Two hundred and ninety-eight women considered suitable for the local outpatient management of cervical intraepithelial neoplasia. METHODS Two groups of patients were identified: group A consisted of women who had cervical intraepithelial neoplasia confirmed colposcopically and who underwent directed punch biopsy; group B consisted of women who had cervical intraepithelial neoplasia confirmed colposcopically and were referred for large loop excision of the transformation zone without confirmatory punch biopsy. RESULTS In Group A (n = 184) 123 women had cervical intraepithelial neoplasia diagnosed on punch biopsy. Large loop excision of the transformation zone was performed on 116 women and 7 were lost to follow up. The procedure confirmed cervical intraepithelial neoplasia in 95 cases (82%), but there was no cervical intraepithelial neoplasia in 21 cases (18%). Sixty-one women had negative punch biopsies. Of these, 13 underwent large loop excision of the transformation zone, 31 had persistently negative follow up cytology, and 9 had positive cervical smears of which 7 were treated with large loop excision of the transformation zone, and 8 were lost to follow up. Overall, 25% of all negative punch biopsies were falsely negative. In group B 114 were treated with large loop excision of the transformation zone and cervical intraepithelial neoplasia was confirmed in 97 cases (85%); one woman had unsuspected microinvasion (1%) and 16 women (14%) had no cervical intraepithelial neoplasia. Negative histology after large loop excision of the transformation zone was not statistically different in groups A and B. CONCLUSION Punch biopsy does not reduce the occurrence of negative histology after large loop excision of the transformation zone.
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Affiliation(s)
- L A Denny
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa
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45
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Soeters R, Denny L, Nevin J, Dehaeck K, Bloch B. Lletz look before we leep. S Afr Med J 1995; 85:3-4. [PMID: 7784913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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46
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Bloch B, Nevin J, de Haeck K, Soeters R, Denny L. Cancer of the cervix--death by neglect. S Afr Med J 1994; 84:318. [PMID: 7740372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- B Bloch
- Gynaecological Oncology Unit, University of Cape Town
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47
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Denny L. The royal hospitals of the City of London. Ann R Coll Surg Engl 1973; 52:86-101. [PMID: 4576457 PMCID: PMC2388168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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