Triage Approach Research Articles

Human Papillomavirus Infections: Current Concepts, New Developments

New epidemiologic and biologic knowledge of the natural history genital human papillomavirus (HPV) infections is rapidly being accumulated. There is overwhelming evidence that most HPV infections are transient particularly in the adolescent, and are not clinically important. There is a small proportion of adult women however, who harbour persistent HPV infections. These women are at considerable risk of developing high grade intra-epithelial neoplasia, and, if undetected and untreated invasive carcinoma.Screening, diagnostic, and management strategies should be tailored according to the HPV-related carcinoma risk potential of a specific area in the lower genital tract. The cervix is undoubtedly the site which carries the highest carcinoma risk among the areas along the lower genital tract. Molecular technology is now available or detecting and typing efficiently HPV DNA. This HPV testing has been shown to be useful in guiding management of women with minor grade cytologic atypia. The HPV DNA triage approach considerably reduces unnecessary colposcopies and the cost of managing this category o women.Several alternatives are available for treating patients with genital HPV infections. The most attractive advances made in the treatment of infra-epithelial cervical lesions and external genital warts are the loop electrosurgical excision procedure and the topical application of an immuno-enhancer agent respectively. The ultimate goal for the prevention and treatment of HPV infections is centred on the development of HPV vaccines.

The Use of Mechanistically Defined Chemical Mixtures (MDCM) to Assess Component Effects on the Percutaneous Absorption and Cutaneous Disposition of Topically Exposed Chemicals.: I. Studies with Parathion Mixtures in Isolated Perfused Porcine Skin

Recently, attention has been directed to the risk assessment of cutaneous exposure to chemical mixtures rather than to only a single compound since this is the exposure scenario in the environment, residence, and work place. Using acetone or dimethylsulfoxide (DMSO) (80% in water) as a vehicle, percutaneous absorption and cutaneous disposition of parathion (PA) were studied following PA (40 μg/cm2) dosing on isolated perfused porcine skin as mechanistically defined chemical mixtures (MDCM) consisting of the surfactant sodium lauryl sulfate (SLS), the rubefacient methyl nicotinate (MNA), and the reducing agent stannous chloride (SnCl2). A full 2 × 4 factorial design was used to asses treatment effects and potential interactions. More radiolabel was absorbed with DMSO than with acetone albeit an earlier peak flux time but lower peak flux was observed with acetone than with DMSO. The absorption flux rate profiles with DMSO continued increasing but bipeak-featured profiles were observed with acetone. SLS enhanced PA absorption with both DMSO and acetone. The presence of MNA in both vehicles blunted the absorption rate curves without significantly changing total absorption. SnCl2blocked PA absorption and increased residue level on the skin surface and in the stratum corneum (SC). The venous flux profiles were mixture-dependent and highly reproducible within treatment groups. Higher level interactions were also noted. This study indicated multiple levels of interactive effects on PA absorption which must be incorporated into any effort to identify critical mechanisms which affect risk assessment of topically exposed mixtures. It was suggested that the chemicals selected in a topically applied mixture may have significant effects on the penetration/distribution pattern and percutaneous absorption profile of a toxicant/drug in the mixture. The MDCM approach may be useful in a screening or triage approach to identify mixture components which affect marker chemical absorption as well as identify potential mechanisms which deserve further attention. Risk assessment efforts could then be focused on those mixtures, containing these critical components, which would be expected to have the greatest penetration and absorption.

Management of Thoracic Trauma and Chest Wall Reconstruction

This article reviews common causes and types of thoracic trauma in the dog. A triage approach for the diagnosis and immediate treatment of thoracic trauma is presented. Reconstructive procedures of the thoracic wall, which may be necessary following trauma or surgical resection of diseased tissue, are described.

Factors affecting compliance in colorectal cancer screening. Results of a study performed in Ballarat.

Non-compliance in screening programmes for colorectal cancer is likely to be the most important factor limiting the impact of screening on mortality. This study aimed to determine risk factors and correlates of compliance that could be readily identified by general practitioners. A total of 581 eligible subjects aged 40 to 75 years completed a questionnaire that covered demographic factors, personal medical history, family history of colorectal cancer and smoking status. Faecal occult blood tests were then offered by the general practitioner and compliance correlated with responses. The over-all compliance was 44% and increased to 51% for those who accepted the self-testing kit at consultation. For men, compliance increased with increasing level of education and was significantly greater for non-smokers than for smokers. For women, compliance increased with increasing age, and was greater for those with either symptoms and/or a family history of colorectal cancer. A doctor group-practice factor appeared to influence acceptance versus refusal of the test kit from the doctor. A triage approach to screening in general practice may improve over-all compliance and the yield of tumours. With this strategy, patients at high risk (for example, those with a family history of colorectal cancer or in older age groups) are identified first. Particular attention should be given during consultation to those at high risk who have poor compliance profiles (for example male smokers with a family history of colorectal cancer). High-risk subjects with high compliance profiles would need less attention and low-risk individuals would need least attention.