Emakakaelavähi varajase avastamise võimalused sõeluuringul. 2003. aastal alustatud sõeluuringu eelprojekt Eestis

Emakakaelavähi varajaseks avastamiseks ning ennetamiseks kasutatakse sõeluuringut. Sõeluuringu efektiivseks korraldamiseks on vaja organiseerida üleriigiline programm, mille eesmärgiks on vähieelsete seisundite diagnoosimine uuritaval sihtrühmal ja nende adekvaatne ravi. Eestis puudub organiseeritud sõel-uuringu programm ning 2003. aastal alustatud eelprojekt on esimeseks sammuks selle väljatöötamisel. Eesti Arst 2006; 85 (12): 834–83

Inimese papilloomiviirusega nakatunud patsientide ravi ja jälgimine

Inimese papilloomiviirusega nakatunud patsientide ravi ja jälgimine on keeruline ning aeganõudev. Puudub spetsiifiline ravi. Ravimeetodeid on palju, kuid nende efektiivsus on limiteeritud ja võimalikud on sagedased haiguse retsidiivid. Iga konkreetse patsiendi raviplaan on individuaalne. Eesti Arst 2002; 81 (10): 660–66

Emakakaelavähi sõeluuringu korraldus ja tulemused Eestis

Emakakaelavähi ja emakakaela prekantseroossete seisundite avastamiseks kasutatakse tsütoloogilist Pap-testi. Organiseeritud emakakaelavähi sõeluuring on tõenduspõhine meede, mis vähendab emakakaelavähki haigestumist ja suremust. Üleeestilist emakakaelavähi sõeluuringut alustati 2003. aastal. Aastatel 2003–2008 on emakakaelavähi sõeluuringus osalenud 48 987 naist. Vähieelne seisund avastati 5,6%-l uuritutest ning kokku on avastatud üle 30 emakakaelavähi juhu. Eestis on emakakaelavähi sõeluuring toimunud suhteliselt lühikest aega, mistõttu mõju emakakaelavähki haigestumusele ja suremusele ei ole veel avaldunud. Eesti Arst 2009; 88(11):748−75

Functional characterization of cytokine autoantibodies in chronic renal failure patients

Functional characterization of cytokine autoantibodies in chronic renal failure patients. We have recently reported on an increase of IL-1α and IL-6 autoantibodies in patients maintained on chronic hemodialysis treatment. The aim of the present study was to evaluate functional properties of these autoantibodies. Serum samples of more then 500 chronic renal failure patients with and without replacement therapy were screened for the presence of IL-1α and IL-6 autoantibodies by second antibody precipitation. The neutralizing capacity of IL-1α autoantibody serum was studied by immunofluorescence flow cytometry analysis of IL-1α induced expression of E-selectin (ELAM-1, CD62e) on HUVEC (human umbilical vein endothelial cells). Results of these inhibition studies were confirmed with IgG preparations from antibody positive sera, purified by affinity chromatography. Functional studies on IL-6-dependent B9 cell proliferation were performed with IL-6 autoantibody positive sera, and quantitated with the colorimetric MTT assay. IL-1α induced expression of E-selectin on HUVEC (considered 100% positive cells) was inhibited by each IL-1α autoantibody positive serum sample (N = 13; anti-IL-1α activity: 7.62 to 57.52% binding). Inhibition of E-selectin expression by IL-1α autoantibodies ranged from 0.11 to 80.22% positive cells (0.15 to 92.31% mean fluorescence intensity). A strong correlation of E-selectin expression with IL-1α autoantibody concentration was observed (P < 0.005). Furthermore, IgG eluates from autoantibody positive patients inhibited E-selectin expression to 41.0 ± 23.1% positive cells if compared with 83.7 ± 5.7% positive cells of the IgG depleted serum samples. IgG eluates and IgG depleted sera derived from anti-IL-1α negative serum samples had no major influence on E-selectin expression (79.9 ±28.5% and 77.9 ± 16.8%, respectively). IL-6 autoantibody sera (N = 11; anti-IL-6 activity: 5.85 to 53.28% binding) had no inhibitory effect on B9 cell proliferation (1:1000: 102.1 ± 7.1%, 1:100: 106.8 ± 9.2%, 1:10: 146.2 ± 26.6% proliferation). We conclude that IL-1α autoantibodies in chronic renal failure patients deliver inhibitory activity on IL-1α, at least in vitro. IL-6 autoantibodies were not found to influence IL-6 dependent proliferation of B9 cells

Gender differences in clinical presentation and surgical outcome of aortic stenosis

Little is known about the gender differences of patients undergoing aortic valve replacement (AVR) for isolated severe aortic stenosis

Assessment of myocardial viability by dobutamine echocardiography, positron emission tomography and thallium-201 SPECT Correlation with histopathology in explanted hearts

AbstractObjectives. We examined the relationship among viability assessment by dobutamine echocardiography (DE), positron emission tomography (PET) and thallium-201 single-photon emission computed tomography (Tl-SPECT) to the degree of fibrosis.Background. DE, PET and Tl-SPECT have been shown to be sensitive in identifying viability of asynergic myocardium. However, PET and Tl-SPECT indicated viability in a significant percentage of segments without dobutamine response or functional improvement after revascularization.Methods. Twelve patients with coronary artery disease and severely reduced left ventricular function (EF 14.5 ± 5.2%) were studied with DE prior to cardiac transplantation: 5 had additional PET and 7 had Tl-SPECT studies. Results of the three techniques were compared to histologic findings of the explanted hearts.Results. Segments with >75% viable myocytes by histology were determined to be viable in 78%, 89% and 87% by DE, PET and Tl-SPECT; those with 50–75% viable myocytes in 71%, 50% and 87%, respectively. Segments with 25–50% viable myocytes showed response to dobutamine in only 15%, but were viable in 60% by PET and 82% by Tl-SPECT. Segments with <25% viable myocytes responded to dobutamine in 19%; however, PET and Tl-SPECT demonstrated viability in 33% and 38%, respectively. Discrepant segments without dobutamine response but viability by PET and SPECT had significantly more viable myocytes by pathology than did those classified in agreement to be nonviable but had significantly less viable myocytes than those classified in agreement to be viable (p < .001).Conclusions. These findings suggest that contractile reserve as evidenced by a positive dobutamine response requires at least 50% viable myocytes in a given segment whereas scintigraphic methods also identify segments with less viable myocytes. Thus, the methods may provide complementary information: Nuclear techniques appear to be highly sensitive for the detection of myocardial viability, and negative tests make it highly unlikely that a significant number of viable myocytes are present in a given segment. Conversely, dobutamine echo may be particularly useful for predicting recovery of systolic function after revascularization