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Jorma Paavonen

Publications and source records attributed to Jorma Paavonen.

11 recordsLinked to original sources
PubMed2003

Observer agreement with laparoscopic diagnosis of pelvic inflammatory disease using photographs.

OBJECTIVE: To test the intraobserver (are observers likely to agree between themselves?) and interobserver (are observers likely to agree with other observers?) reproducibility and the overall diagnostic accuracy of laparoscopic diagnosis of pelvic inflammatory disease (PID). METHODS: Three senior consultants and three residents in training in obstetrics and gynecology scored the four laparoscopic images (adnexa, cul-de-sac, and pelvic panoramic view) from each of 40 patients and repeated the process 2 days later after the order of presentation had been randomized. A standardized predesigned scoring form was used. Histopathologically proven PID was used as the gold standard. RESULTS: The overall accuracy of the laparoscopic diagnosis of PID was 78%, the sensitivity was 27%, and the specificity was 92%. The overall intraobserver reproducibility of the diagnosis of PID was only fair (kappa = 0.58), and it was clearly better among the consultants than among the residents (kappa = 0.76 and 0.39, respectively). The overall interobserver reproducibility was poor to fair (kappa = 0.43), and it was again better among the consultants than among the residents (kappa = 0.48 and 0.38, respectively). When specific diagnostic features (including tubal erythema, edema, adhesions, cul-de-sac fluid) were separately analyzed, the results were no different suggesting only poor-to-fair reproducibility. CONCLUSION: Based on photographic images, the observer reproducibility and the overall diagnostic accuracy of the laparoscopic diagnosis of PID are unsatisfactory when histopathologically proven PID is used as the gold standard.

Female↗
PubMed2003

Evaluation of antibody response to human papillomavirus early proteins in women in whom cervical cancer developed 1 to 20 years later.

OBJECTIVE: Infection with oncogenic human papillomaviruses (HPVs) is the most important cause of cervical cancer worldwide. After infection there is a long latency period of at least 10 to 15 years during which cervical cancer develops in a small proportion of originally infected women. Up to 50% of these women have at diagnosis antibodies to the HPV oncoproteins E6 and E7, which are rarely found among healthy women. Our purpose was to evaluate whether antibodies to HPV16 and HPV18 E6 and E7 proteins are useful for early diagnosis of cervical cancer by measuring the antibody response in women in whom cervical cancer later developed. STUDY DESIGN: A joint serum bank of 550,000 Swedish, Norwegian, and Finnish women was followed up for 0.5 to 20 years, after which 178 invasive cervical carcinoma (ICC) cases, 150 of whom had squamous cell carcinoma (SCC), and 527 controls were identified. Antibodies to HPV16 and HPV18 E6 and E7 proteins were determined by tag enzyme-linked immunoassays. RESULTS: HPV16/18 E6 and E7 antibodies were detected infrequently (7.0%) in women in whom SCC later developed and yielded a moderately increased estimate of associated relative risk (odds ratio 2.7, 95% CI 1.1-6.4). Sensitivity of the combined antibody tests for the detection of occult SCC varied between 6% and 14% but was not related to time lag between serum sampling and cancer diagnosis. CONCLUSION: HPV16/18 E6 and E7 antibody responses are not sensitive markers of occult cervical cancer.

Adult↗
PubMed2003

Criteria for selective screening for Chlamydia trachomatis.

BACKGROUND: On the basis of studies in ethnically diverse populations, it appears that the best strategy for prevention of infections is screening of all women aged 25 years or younger. GOAL: The goal was to determine screening criteria in an ethnically and socioeconomically homogenous population with low prevalence of genital chlamydia infection. STUDY DESIGN: Women (N = 1198) attending two family planning clinics were screened for and surveyed for risk factors. Data were analyzed with multivariate logistic regression. RESULTS: The overall prevalence of infection was 3.5%. Risk markers for the infection included marital status, number of sex partners, and age. Screening women aged 25 years or younger would have identified 28% of all chlamydial infections, while screening all women aged 30 years or younger would have identified 83% of infections. CONCLUSION: Because of its feasibility, age appears to still be the best screening criterion. However, extension of the screening to include women up to 30 years of age should be considered.

Adolescent↗
PubMed2002

A population-based prospective study of Chlamydia trachomatis infection and cervical carcinoma.

Persistent human papillomavirus (HPV) infection is an established cause of cervical cancer, but the role of other sexually transmitted agents, most notably Chlamydia trachomatis, has not been well defined. The women participating in the population-based cervical cancer screening program in Västerbotten county of Northern Sweden were followed up for up to 26 years to identify 118 women who developed cervical cancer after having had a normal Pap smear (on average 5.6 years later; range 0.5 months-26 years). As controls, we selected another 118 women who were matched by birth cohort, time-point of sampling of the baseline normal smear and who had a normal smear at the time when the corresponding case was diagnosed with cancer. The Pap smears and cervical cancer biopsies were analyzed by PCR for C. trachomatis DNA and for HPV DNA. At baseline, C. trachomatis DNA was present in 8% of cases but not among any one of the controls. The relative risk for cervical cancer associated with past C. trachomatis infection, adjusted for concomitant HPV DNA positivity, was 17.1 (95% CI 2.6-infinity). The presence of C. trachomatis and of HPV were not interrelated. Whereas C. trachomatis was primarily found in specimens taken many years before cancer diagnosis, HPV DNA was associated with a short lag time before cancer diagnosis. Whereas most women who were HPV DNA-positive in the prediagnostic smear were also positive for the same virus in the cervical cancer biopsy, none of the women were positive for C. trachomatis in both the prediagnostic smear and in the subsequent cervical cancer. In conclusion, a prior cervical C. trachomatis infection was associated with an increased risk for development of invasive cervical cancer.

Adult↗
PubMed2002

Chlamydial heat shock protein 60--specific T cells in inflamed salpingeal tissue.

OBJECTIVE: To evaluate the role of chlamydial heat shock protein 60 (CHSP60)-specific T-lymphocytes in tubal factor infertility. DESIGN: Case series of patients with tubal factor infertility. SETTING: Infertility Clinic, Department of Obstetrics and Gynecology, Helsinki University Central Hospital and Laboratory of Cell-Mediated Immunity, National Public Health Institute, Oulu, Finland. PATIENT(S): Five patients with tubal factor infertility who underwent elective salpingectomy because of hydrosalpinges. INTERVENTION: Collection of salpingeal tissue specimens for in vitro culture of T-lymphocytes. MAIN OUTCOME MEASURE(S): Cloning of Chlamydia trachomatis and CHSP60-specific T-lymphocyte lines derived from inflamed salpingeal tissue. Cytokine production analysis of the established T-lymphocyte clones. RESULT(S): Seventy-seven (34%) of the 229 T-lymphocyte clones recognized C. trachomatis and C. pneumoniae elementary bodies as target antigens. One-third of these Chlamydia genus-specific T-lymphocyte clones further recognized CHSP60 as the target antigen. Most of the CHSP60-specific T-lymphocyte clones produced predominantly IL-10. CONCLUSION(S): CHSP60 may be an important T-lymphocyte antigen involved in the immunopathogenesis of tubal damage associated with chronic C. trachomatis infection.

Adult↗
PubMed2002

The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review.

Screening women for lower genital tract infection with Chlamydia trachomatis is important in the prevention of pelvic inflammatory disease, ectopic pregnancy and infertility. This systematic review aims to state clearly which of the available diagnostic tests for the detection of C. trachomatis would be most effective in terms of clinical effectiveness. The review included all studies published from 1990 onward that evaluated diagnostic tests in asymptomatic, young, sexually active populations. Medline and Embase were searched electronically and key journals were hand-searched. Further studies were identified through the Internet and contact with experts in the field. All studies were reviewed by two reviewers and were scored by Irwig's assessment criteria. Additional quality assessment criteria included a documented sexual history and recording of previous chlamydial infection. The reviews were subjected to meta-analysis and meta-regression. The 30 studies that were included examined three types of DNA-based test--ligase chain reaction (LCR), PCR and gene probe--as well as enzyme immuno-assay (EIA). The results showed that while specificities were high, sensitivities varied widely across the tests and were also dependent on the specimen tested. Pooled sensitivities for LCR, PCR, gene probe and EIA on urine were 96.5%, 85.6%, 92% and 38%, respectively, while on cervical swabs the corresponding sensitivities of PCR, gene probe and EIA were 88.6%, 84% and 65%. Meta-analysis demonstrated that DNA amplification techniques performed best for both urine and swabs in low prevalence populations. We conclude that nucleic acid amplification tests used on non-invasive samples such as urine are more effective at detecting asymptomatic chlamydial infection than conventional tests, but there are few data to relate a positive result with clinical outcome.

Cervix Uteri↗