Efficacy, safety and tolerability of green tea catechins in the treatment of external anogenital warts: a systematic review and meta-analysis.

BACKGROUND: External anogenital warts (EGWs) are non-malignant skin tumours caused by human papillomavirus. They are one of the fastest growing sexually transmitted diseases. Current treatments are unsatisfactory. Green tea sinecatechin Polyphenon E ointment is a botanical extract from green tea leaves exhibiting anti-oxidant, anti-viral and anti-tumour properties. OBJECTIVE: The aim of this study was to integrate valid information and provide basis for rational decision making regarding efficacy and safety of green tea extracts in the treatment of EGWs. METHODS: A systematic search in electronic databases was conducted using specific key terms. Main search was performed independently by two reviewers. The accumulated relevant literature was subsequently systematically reviewed and a meta-analysis was conducted. RESULTS: Three randomized, double-blind, placebo-controlled studies evaluating efficacy and safety of Polyphenon E 15% and 10% in the treatment of warts were included in the systematic review and meta-analysis. A total of 660 men and 587 women were enrolled. Regarding primary outcome, both Polyphenon E 15% and 10% demonstrated significantly higher likelihood of complete clearance of baseline and baseline and new warts compared with controls. No significant heterogeneity was detected. Recurrence rates were very low. Commonest local skin sign was erythema and local skin symptom was itching. CONCLUSIONS: Efficacy of Polyphenon 15% and 10%, at least for the primary endpoint, is clearly indicated. Polyphenon E treatment exhibits very low recurrence rates and appears to have a rather favourable safety and tolerability profile. Recommendations for future studies should include evaluation of the efficacy of green tea catechins in the treatment of internal anogenital warts and direct comparison with its principal comparator, imiquimod.

Pregnancy-associated breast cancer--a review analysis.

UNLABELLED: The aim of the present review was to assess the relationship between pregnancy and/or lactation and breast cancer, the influence of pregnancy on mortality and prognosis of the disease, the consequences of breast cancer to the current pregnancy and also to discuss the future perspective for women's fertility. MATERIALS AND METHODS: Articles were obtained from Medline (1988 present) using as keywords breast cancer, pregnancy, breastfeeding, lactation, carcinoma and pregnancy. RESULTS: Unfortunately, delays in diagnosis and treatment are common during pregnancy and the prognosis is thus worsened. Nulliparity, early menarche and late age at first pregnancy are associated with increased risk for breast cancer. Breastfeeding confers a protective effect on risk of breast cancer, which appears to be related to the duration of breastfeeding. In cases of advanced metastatic disease during the first 14 to 15 weeks of pregnancy when chemotherapy is necessary for prompt treatment, termination of pregnancy may be proposed, particularly if the patient is ER-positive. Modified radical mastectomy is probably the procedure most frequently used today. In general chemotherapy should be delayed until after 14 to 15 weeks of gestation and radiation should be reserved until post delivery. Several authorities generally advise that future pregnancy should be delayed for at least two years after breast cancer treatment. CONCLUSION: Breast cancer has an equivalent prognosis in pregnant and non pregnant patients when matched by age and stage at diagnosis. Women are invariably best treated by multidisciplinary teams.

Verification of the accuracy of cervical cytology reports in women referred for colposcopy.

OBJECTIVE: To verify the accuracy of cervical cytology in correlation with colposcopic and histological findings. DESIGN/SETTING/POPULATION/METHODS: In this retrospective chart review study 545 women, referred to the outpatient clinic for colposcopy, were included in the study. During the 4-year study period, two consultants performed the colposcopies and further necessary procedures, whereas patient charts were reviewed by two of the co-authors. RESULTS: The median age of the study population was 35 years (range: 16-65). Thirty-four percent of the cases were new and 11% of the women were referred after receiving their first ever cervical smear. Ninety-two percent (503/545) of the colposcopies were satisfactory. Concordance between colposcopic findings and the histology report was 87%, whereas concordance between cytology and histology reports was as low as 60% for HPV-related lesions, 72% for LGSIL and 86% for HGSIL. "See and Treat" was offered to 53 (10%) women and 48 (90.5%) of them had high-grade lesions on histology justifying treatment at the first visit. CONCLUSIONS: The concurrent use of cytology and colposcopy provides better chances for earlier detection of lesions demanding intervention; 80%-90% of patients with severe dyskaryotic smears will have a histology report confirming CIN III. See and treat management can be decided sometimes, if supported by the colposcopic findings, and an audit should confirm accuracy to, at least, 90% of cases.

D-dimer levels as a predicting factor for DIC following single twin death: a case report and review of the literature.

BACKGROUND: Intrauterine death of one twin in the second or third trimester occurs in about 1% of all twin pregnancies. The retention in utero of the dead fetus may be associated with maternal disseminated intravascular coagulation. CASE: We present the case of a diamniotic monochorionic pregnancy with intrauterine death of the first twin at 24 weeks. The pregnancy reached 33 weeks. In our case although all coagulation factors were within normal limits, D-dimer levels were significantly high, without any evidence though of any clotting problems to the mother. CONCLUSION: The role of D-dimers is practically unknown in multiple pregnancies. It seems that the interpretation of elevated D-dimer levels is still of limited value for prediction or prognosis of thromboembolic complications of multiple pregnancies.

PDE5 inhibitors: in vitro and in vivo pharmacological profile.

PDE5 inhibitors have been clearly established as first-line therapy for the treatment of erectile dysfunction (ED). Three PDE5 inhibitors--sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis)--are currently approved by the FDA and the EMEA for use in ED, whereas sildenafil is also marketed under a different proprietary name (Revatio) for the treatment of pulmonary arterial hypertension (PAH). A forth PDE5 inhibitor, udenafil (Zydena), is currently marketed. In the present review the molecular basis and the mechanism of action of PDE5 inhibitors is discussed. In addition experimental and clinical data concerning their effects on different tissues, organs and systems is systematically reviewed and their possible beneficial action in numerous disorders is presented.