See related commentary by Kanis, page [1829][1]

Since the publication of the Osteoporosis Canada guidelines in 2002, there has been a paradigm shift in the prevention and treatment of osteoporosis and fractures. [1][2],[2][3] The focus now is on preventing fragility fractures and their negative

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2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary

This report updates and combines earlier versions of guidelines for the prevention and treatment of opportunistic infections (OIs) in HIV-infected adults (i.e., persons aged >/=18 years) and adolescents (i.e., persons aged 13--17 years), last published in 2002 and 2004, respectively. It has been prepared by the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by clinicians and other health-care providers, HIV-infected patients, and policy makers in the United States. These guidelines address several OIs that occur in the United States and five OIs that might be acquired during international travel. Topic areas covered for each OI include epidemiology, clinical manifestations, diagnosis, prevention of exposure; prevention of disease by chemoprophylaxis and vaccination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; discontinuation of secondary prophylaxis after immune reconstitution; and special considerations during pregnancy. These guidelines were developed by a panel of specialists from the United States government and academic institutions. For each OI, a small group of specialists with content-matter expertise reviewed the literature for new information since the guidelines were last published; they then proposed revised recommendations at a meeting held at NIH in June 2007. After these presentations and discussion, the revised guidelines were further reviewed by the co-editors; by the Office of AIDS Research, NIH; by specialists at CDC; and by HIVMA of IDSA before final approval and publication. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of evidence supporting the recommendation, so that readers can ascertain how best to apply the recommendations in their practice environments. Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for the prevention and treatment of OIs, especially those OIs for which no specific therapy exists; 2) information regarding the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information regarding the use of interferon-gamma release assays for the diagnosis of latent Mycobacterium tuberculosis (TB) infection; 4) updated information concerning drug interactions that affect the use of rifamycin drugs for prevention and treatment of TB; 5) the addition of a section on hepatitis B virus infection; and 6) the addition of malaria to the list of OIs that might be acquired during international travel. This report includes eleven tables pertinent to the prevention and treatment of OIs, a figure that pertains to the diagnois of tuberculosis, a figure that describes immunization recommendations, and an appendix that summarizes recommendations for prevention of exposure to opportunistic pathogens.

Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.

Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.

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Acog practice bulletin

https://www.asccp.org/Assets/405b4550-593f-40a7-ae25-0c783de95b0d/635912114192570000/asccp-updated-guidelines-3-21-13-pdf

2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors

ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists

Purpose

The purpose of this study was to evaluate the capability of transvaginal sonography to differentiate adenomyomas from leiomyomas.



Methods

Two hundred six patients scheduled for surgery for symptomatic uterine masses underwent preoperative transvaginal sonography. Sonographic findings were compared with pathologic findings. Pathologic findings showed that 111 patients had leiomyomas, 48 had diffuse adenomyosis, 31 had adenomyomas, and 4 had leiomyosarcomas.



Results

For the diagnosis of adenomyoma, transvaginal sonography demonstrated a sensitivity of 82.0%, specificity of 88.3%, positive predictive value of 84.6%, and negative predictive value of 87.5% compared with a sensitivity of 95.1%, specificity of 82.0%, positive predictive value of 90.7%, and negative predictive value of 85.7% for the diagnosis of leiomyoma. Two sonographic characteristics, lesion margin (p = 0.0001) and lacunae (p = 0.0001), allowed the differentiation of adenomyoma from leiomyoma.



Conclusions

Transvaginal sonography is an effective procedure for the preoperative differentiation of adenomyoma from leiomyoma. If the status of the lesion's margins and the presence or absence of hypoechoic lacunae were selected for analysis, leiomyomas could be correctly diagnosed with transvaginal sonography in 95% of cases. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound26: 21–25, 1998.

Adenomyoma and leiomyoma: Differential diagnosis with transvaginal sonography

OBJECTIVE To determine the interpretability and significance of the traditional factors used to predict residual dysplasia in hysterectomy specimens after loop conization. MATERIALS AND METHODS Loop electrosurgical cervical conization was performed on 372 patients. Ninety three women had a hysterectomy within 6 months of the loop conization. Residual disease was defined as cervical intraepithelial neoplasia or cancer in the hysterectomy specimen. RESULTS Of the 93 patients having a subsequent hysterectomy, 36 (38.7%) has residual disease in their hysterectomy specimen. The mean age of the patients with residual disease in the post loop conization hysterectomy specimen was 42.22. The mean age of those free of residual disease was 29.42. By multivariate analysis, dysplasia involving the ectocervical margin (p = 0.34) and the endocervical margin (p = 0.35) was not predictive of disease in the hysterectomy specimens. Endocervical curettage (p = 0.005), glandular involvement (p = 0.01), loop conization pathology findings (p < 0.05) and cytological examination (p < 0.001) were predictive of residual dysplasia. CONCLUSIONS Cytological reports, increasing age, severity of disease, gland involvement and endocervical curettage were the only factors that accurately predicted residual dysplasia. The presence or absence of dysplasia in the loop conization, ectocervical margin and endocervical margin was not predictive of residual dysplasia in post loop conization hysterectomy specimens.

Predictive factors used to justify hysterectomy after loop conization: increasing age and severity of disease.

Objective To determine the number of patients with carcinoma in situ of the cervix treated by hysterectomy who proceeded to develop vaginal intraepithelial neoplasia (VAIN) and define whether the subsequent development of VAIN justifies intensive cytology and colposcopy follow-up. Materials and methods Nine hundred and ninety-three women who were subjected to hysterectomy with CIN, (793 patients had completed 10 years of cytology and colposcopy follow-up) were identified. Results Forty-one patients with VAIN presented with CIN 3 after hysterectomy. The upper one half of the vagina was the area more affected. The middle age group developed VAIN in the shortest time. Atypical Cells (ASCUS) were found in 42% of these patients. Colposcopy revealed VAIN involving the vault angles of the suture line in 54% of the cases. In 51% of the cases the grade of vaginal abnormality was the same as that of the original lesion in the cervix. Conclusion With such data we would propose screening over a 5-year period. Follow-up should also include colposcopic review during every examination.

Vaginal Intraepithelial Neoplasia (VAIN) Following Hysterectomy in Patients Treated for Carcinoma In Situ of the Cervix

A simple method is presented for the minimal state-space representation, described by the Roesser model, of a 2-D all-pole and all-zero transfer function. The state-space representation is derived, from a block diagram, by inspection. General expressions for the system matrices (A, b, c) of very simple form are derived explicitely in terms of the parameters of the transfer function.

George Antoniou

Papers

Adenomyoma and leiomyoma: Differential diagnosis with transvaginal sonography

Predictive factors used to justify hysterectomy after loop conization: increasing age and severity of disease.

Vaginal Intraepithelial Neoplasia (VAIN) Following Hysterectomy in Patients Treated for Carcinoma In Situ of the Cervix

On the minimal state-space realizations of all-pole and all-zero 2-D systems

Vaginal intraepithelial neoplasia (VAIN) following hysterectomy in patients treated for carcinoma in situ of the cervix.