Higher Incidence of Abnormal Pap Smears in Women With Inflammatory Bowel Disease
ABSTRACT Immunosuppression results in a higher incidence of cervical dysplasia compared with healthy controls. We examined the relationship between immunomodulator use and the presence of abnormal cervical histology in women with inflammatory bowel disease (IBD).
Women with IBD and serial Pap smears were recruited. Patients were compared to age-, race-, and parity-matched controls. Pap smears were recorded in relation to exposure to immunomodulators. Variables included diagnosis, type and duration of immunosuppressant, and smoking.
Forty patients (8 UC, 32 CD) with 134 Pap smears were included. The incidence of any abnormal Pap in a woman with IBD was 42.5%versus 7% of controls (P < 0.001). Women with IBD were more likely to have higher-grade lesions than controls (P < 0.001). Those women with a history of exposure to immunosuppression were more likely to have an abnormal Pap smear (P < 0.001) than controls. Pap smears done with > 6 months exposure to an immunosuppressant resulted in increased risk (OR 1.5, 1.2-4.1, P= 0.021). Cytopathology of abnormal lesions revealed either HPV serotype 16 or 18 in all specimens. Multivariate analysis did not reveal any differences between the groups when controlled for other variables.
Women with IBD have a higher risk of an abnormal Pap smear compared with healthy controls. Patients with immunomodulator use have a higher risk of an abnormal Pap smear associated with HPV infection. Women with IBD should be included in the American College of Obstetrics and Gynecology screening guidelines for immunocompromised individuals.
Conference Paper: Designer Controlled Behavioral Synthesis[Show abstract] [Hide abstract]
ABSTRACT: This paper describes features of EXEL, a graphic language that gives the designer control over the behavioral synthesis process. Control is achieved by allowing the designer to partially specify the structural design into which the description is going to be compiled, or by binding desired variables and operators to particular components or connections, and binding desired operations to particular states of the final design. EXEL's compiler runs on SUN-3 workstations and is written in C and SUNVIEW.Design Automation, 1989. 26th Conference on; 07/1989
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ABSTRACT: Crohn's disease and ulcerative colitis are chronic inflammatory conditions involving the gastrointestinal tract. Although many aspects of the management of these diseases are identical for all patients, some issues that are specific to women are not necessarily part of routine care. Gender-specific issues such as menses, fertility, pregnancy, and menopause are often overlooked and mismanaged. Women and men also have different psychological concerns arising from the disease. Health care providers, regardless of their primary focus, should be aware of these differences and should be familiar with certain general information on gender-specific issues, reviewed in this article.The journal of gender-specific medicine: JGSM: the official journal of the Partnership for Women's Health at Columbia 02/2001; 4(1):54-9.
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ABSTRACT: Guidelines for clinical practice are intended to indicate preferred approaches to medical problems as established by scientifically valid research. Double-blind placebo-controlled studies are preferable, but compassionate use reports and expert review articles are utilized in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identified as a consensus of experts. Guidelines are applicable to all physicians who address the subject without regard to the specialty training or interests and are intended to indicate the preferable but not necessarily the only acceptable approach to a specific problem. Guidelines are intended to be flexible and must be distinguished from standards of care, which are inflexible and rarely violated. Given the wide range of specifics in any health-care problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. Each has been extensively reviewed and revised by the Committee, other experts in the field, physicians who will use them, and specialists in the science of decision of analysis. The recommendations of each guideline are therefore considered valid at the time of their production based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at the publication in order to assure continued validity.The American Journal of Gastroenterology 08/2004; 99(7):1371-85. DOI:10.1111/j.1572-0241.2004.40036.x · 9.21 Impact Factor