HPV genotype profile in a Norwegian cohort with ASC-US and LSIL cytology with three year cumulative risk of high grade cervical neoplasia.

OBJECTIVE: To explore the HPVgenotype profile in Norwegian women with ASC-US/LSIL cytology and the subsequent risk of high-grade cervical neoplasia (CIN 3+). METHODS: In this observational study delayed triage of ASC-US/LSIL of 6058 women were included from 2005 to 2010. High-risk HPV detection with Hybrid Capture 2 (HC2) was used and the HC2+ cases were genotyped with in-house nmPCR. Women were followed-up for histologically confirmed CIN3+ within three years of index HPV test by linkage to the screening databases at the Cancer Registry of Norway. RESULTS: HC2 was positive in 45% (2756/6058) of the women. Within 3years CIN3+ was diagnosed in 26% of women<34year and in 15%≥34year. HC2 was positive at index in 94% of CIN3+ cases and negative in 64 cases including three women with cervical carcinomas. Women<34years with single infections of HPV 16, 35, 58 or 33 or multiple infections including HPV 16, 52, 33 or 31 were associated with highest proportions of CIN 3+. Older women with single infection with HPV 16, 33, 31 or 35 or multiple infections including HPV 16, 33, 31 or 18/39 were more likely to develop CIN 3+. CONCLUSIONS: HPV 16 and HPV 33 at baseline both as single or multiple infections, were associated with the highest risk for CIN3+. Among older women, all 13 high-risk genotypes as single infection were associated with >20% risk of CIN3+. Further studies are necessary to risk stratify the individual genotypes to reduce the number of colposcopies in Norway.

Comparison of digoxin analysis by EMIT with Immophase and Dac-Cel radioimmunoassay.

The results obtained by an enzyme multiplied immunoassay kit, EMIT, for the measurement of serum digoxin concentration were compared with those from two radioimmunoassay kit methods, Immophase and Dac-Cel. Patients' sera were used to study the correlation between the methods, and three quality control sera with low, intermediate, and high digoxin concentrations were used to study individual method precision. The coefficients of correlation between the three methods varied between 0.915 and 0.951 for serum drug concentrations up to 4.5 nmol/l. There were statistically significant differences between the means of the patients' samples for each method. Precision was acceptable for each method: within-batch percentage coefficient of variation (%CV) less than 8, between-batch %CV less than 10, except for Dac-Cel at low concentration %CV = 18.6. The time taken for the analysis of a batch of 10 samples was between 1.5 and 2 hours, depending on the method.

Stability of propafenone hydrochloride in i.v. solutions.

The stability of propafenone hydrochloride in i.v. solutions was studied. Solutions of propafenone hydrochloride 2, 1, and 0.5 mg/mL in 5% dextrose injection and in 5% dextrose and 0.2% sodium chloride injection were prepared. Portions of each type of solution were transferred to 10-mL polypropylene syringes and to 150-mL polyvinyl chloride (PVC) bags. Syringes and bags were stored at 20.5-22.5 degrees C under fluorescent light. Two 0.5-mL samples were drawn from each container at 0, 6, 12, 24, 36, and 48 hours and frozen in polystyrene tubes at -20 degrees C until assayed. Propafenone concentrations were determined by high-performance liquid chromatography. All samples of propafenone hydrochloride 2 mg/mL in 5% dextrose and 0.2% sodium chloride injection taken from PVC bags precipitated when thawed. For the remaining solutions, the mean decrease from the initial concentration was < 10% regardless of diluent, container type, and initial concentration. Propafenone hydrochloride 1 and 0.5 mg/mL in 5% dextrose injection or in 5% dextrose and 0.2% sodium chloride injection was stable for 48 hours at 20.5-22.5 degrees C when stored in polypropylene syringes or PVC bags. Propafenone hydrochloride 2 mg/mL in 5% dextrose injection was stable for 48 hours when stored in syringes or bags, but in 5% dextrose and 0.2% sodium chloride injection was stable in syringes only.

[Can postoperative nausea or vomiting be predicted?]. / Kan postoperativ kvalme eller oppkast forutsies?

BACKGROUND: In order to identify patients who may benefit from prophylactic anti-emetic medication during surgery, it is of interest to evaluate risk factors for postoperative nausea and vomiting preoperatively by a simple scoring system. MATERIAL AND METHODS: In this retrospective study we evaluated the ability to assess the risk of PONV by a preoperative clinical score developed in our institution (U-score, 0-13 points) and two simple scoring systems from the literature (A-score, 0-4 points and K-score, 0-5 points). 120 patients were interviewed 24 hours after a surgical procedure. Possible risk factors for PONV were scored and compared to the occurrence of PONV. RESULTS: 60% of patients experienced PONV during the first 24 postoperative hours. No difference was seen between those who had received droperidol prophylaxis and those who had not. A significant correlation (p < 0.01) were seen on all scoring systems between occurrence of PONV and high score. With the U-score, 78% of the patients with a score > 7 experienced PONV, compared to only 41% of those with a score < 6. INTERPRETATION: We suggest that patients with a U-score > 7 should receive effective prophylaxis against PONV, i.e. not droperidol only. Further evaluation of different scoring systems should be carried out in larger patient populations. Simplified systems, such as the A-score or K-score or simplified U-score, may be sufficient in uniform surgical populations. The U-score may be more universal because anaesthetic method and use of postoperative opioids are also included.

Propafenone disposition during continuous venovenous hemofiltration.

OBJECTIVE: To determine the extent of removal of propafenone by continuous venovenous hemofiltration (CVVH) in a critically ill pediatric patient. CASE SUMMARY: A three-year-old white-Japanese girl was admitted to the critical care unit following cardiac surgery. Her postoperative course was complicated by the development of junctional ectopic tachycardia, requiring propafenone, and acute renal failure, which necessitated the use of CVVH. The serum and ultrafiltrate concentrations of propafenone and its 5-hydroxy metabolite were measured to determine both total and CVVH clearance. CONCLUSIONS: The data from this case report showed that propafenone was not significantly removed by CVVH. Furthermore, the total clearance of propafenone was not affected by the patient's renal or liver function impairment.

Therapeutic monitoring and pharmacokinetic evaluation of procainamide in neonates.

Past experience with the disposition of procainamide hydrochloride (PA) in neonates is restricted to a single case study involving placental transfer. We studied aspects of PA pharmacokinetics in three neonates who received constant-rate infusion therapy. Results indicated that the total serum clearance of PA is similar to the adult value, but elimination half-lives of both PA and N-acetylprocainamide (NAPA) were slightly prolonged and volume of distribution was variable. Pharmacokinetic evaluations in a renally compromised neonate confirmed that total PA clearance and the renal clearance of both PA and NAPA were reduced, although not to the extent expected for the degree of renal impairment. Peritoneal dialysis was used concurrently and may have contributed to the elimination process. We believe that our experience provides important preliminary guidelines for the management of PA therapy in neonates.