Christos J. Emmanouilides

Prevalence and distribution of high-risk human papillomavirus in Greece.

As knowledge of regional human papillomavirus (HPV) type distribution is essential for the optimization of prevention strategies, this study was carried out to explore the prevalence and type distribution of high-risk HPV in a screening population across Greece. Cervical samples were collected by local physicians and nurses in hospitals and health centers across the country from 4139 women attending for cervical cancer screening. High-risk HPV-DNA was detected by using Hybrid Capture-2 (HC2) and positive samples with adequate cellular content were further typed by restriction fragment length polymorphism-polymerase chain reaction. Almost six percent (5.9%) of women tested positive in HC2. The most common type was HPV16 (1.4% in the whole sample and 32.4% of the typed samples), followed by HPV53 (0.6 and 14.0%, respectively), HPV31 (0.6 and 12.9%, respectively), HPV35 (0.5 and 12.3%, respectively), HPV51 (0.4 and 7.8%, respectively), HPV18 (0.3 and 7.3%, respectively) and 22 more types. Almost 15% of the typed samples showed a coinfection with two HPV types and 2.1% with three types. There was a bimodal distribution by age, with the highest peak in women 20–29 years old and a lower peak in women 50–59 years old. Apart from the types originally included in HC2 cocktail, PCR analysis identified 15 more types (HPV6, HPV11, HPV34, HPV37, HPV38, HPV42, HPV53, HPV54, HPV55, HPV61, HPV62, HPV66, HPV73, HPV82, HPV83). Eleven percent of HC2-positive results arose from single-type infections with HPV53 (10%) and HPV66 (1%), which are potentially high-risk types. In conclusion, HPV16 is the most common type in the largest Greek screening sample used to date and, together with its related types, accounts for more than half of high-risk HPV infections. Approximately 10% of positive HC2 results arise from HPV53, which is not normally detected by the test, but may be clinically significant.

Modelling and estimation of social interaction effects in new product diffusion

We present a new product choice model in which individual agents are assumed to interact with each other across spatial hierarchies under random Gaussian laws. A restricted form that allows estimation of the model and inference on the random interaction structure on available data is then derived. This is essentially a random coefficients model which we estimate on repeated cross-sectional data for the adoption of video cassette recorders in Britain. It is argued that the random coefficient approach, based on economic and social-theoretic arguments allows for more accurate inference on the structure of social interactions, and thus may provide a useful way to help alleviate the inferential problem caused by the identification issues stated in the literature. This very same problem has for long been at the core of the debate between alternative economic and marketing theories of new product diffusion.

Price Linkages in the International Skim Milk Powder Market: Empirical Evidence from Nonparametric and Time‐Varying Copulas

The objective of this article is to assess the integration of the international skim milk powder (SMP) market. This is pursued using monthly data over 2001 to 2014 from the three principal SMP-producing regions (the EU, the USA and Oceania) and nonparametric kernel-based and time-varying copulas. The empirical results point to a strong and an increasing degree of overall price co-movement and to statistically significant probabilities for joint price crashes and booms. While the EU and Oceania have been the regions with the highest degree of integration, the USA has been catching up with them.

Successful management of bulky osseous metastasis of renal cell carcinoma with selective arterial embolization and radiofrequency ablation: a case report

The case of a 64-year-old male patient who presented with a bulky osseous tumor metastasis from renal cell carcinoma is reported. The metastatic lesion extended from the acetabulum of the left iliac bone into the iliosacral joint.Treatment plan included selective arterial embolization followed by transdermal radiofrequency ablation, followed by consolidation irradiation. This sequence resulted in considerable necrosis of the bulk of the tumor and creation of a large tissue deficit, which healed over the period of several months despite anti-angiogenetic systematic treatment. The patient remains in good state of health, 20 months after the procedure. This case illustrates the usefulness of the embolization-ablation sequence in controlling large osseus metastasis.

Adrenalectomy for solitary adrenal metastasis from colorectal cancer: A case report

BackgroundPatients with adrenal metastasis from various primary tumours are regarded as cases of diffuse systemic spread and considered unsuitable for surgical resection. We herein report an operable case of heterochronic adrenal metastasis from colorectal carcinoma in a 63-year-old woman.Case presentationSixteen months after low anterior resection for the primary tumour, left lower pneumonectomy was performed for a solitary lung metastasis. Four months later a right adrenal metastasis was detected by magnetic resonance imaging (MRI), as sole evidence of metastatic disease. A right adrenalectomy was performed. The histopathological examination revealed adenocarcinoma compatible with the colorectal carcinoma resected 19 months earlier. The patient received adjuvant chemotherapy after each operation and is alive and free of disease 21 months after the adrenalectomy.ConclusionThe possibility of adrenal metastasis should be considered in the follow-up of patients after primary surgery for colorectal cancer, even though other sites are the main metastatic sites. Although the prognosis of adrenal metastasis from colorectal cancer is poor, we suggest that patients with solitary adrenal metastasis may benefit from complete removal of it.

Effect of type-specific human papillomavirus incidence on screening performance and cost.

Background: Implementation of human papillomavirus (HPV) vaccination is expected to change the epidemiology of HPV infection. Methods: Using age-dependent (inhomogeneous) Markov chains, we tested the effect of type-specific (ie, HPV-16/HPV-18 and other high-risk HPV types) HPV incidence on 3 screening strategies in a cohort of 100,000 women, starting screening at the age of 25 years and continuing until the age of 34 years. All the strategies started with an HPV test; if the result was positive, the next step was triage with cytology (strategy 1), cytology and colposcopy together (strategy 2), or colposcopy only (strategy 3). Published background data were used for the models. Results: Strategy 2 had the highest sensitivity; the absolute number of missed cervical intraepithelial neoplasia (CIN)3+ cases was associated with HPV incidence in all the strategies, but their relative sensitivity remained unaffected. Strategy 2 was cheaper per diagnosed CIN3+ for very low HPV incidence rates, but this changed for higher incidence rates. For any given pair of HPV-16/HPV-18 and other high-risk-type incidence, the cost of the triage and the total cost of screening was highest in screening 2 and lowest in screening 1. For each screening strategy, the cost per diagnosed CIN3+ was mainly determined by the incidence of HPV-16/HPV-18, and the cost of the triage and the total screening cost by the incidence of other high-risk types. Conclusions: Type-specific HPV incidence affects the absolute number of missed CIN3+ cases and the cost of screening in a mathematically describable way and can be used for prediction of changes in these outcomes with changing HPV epidemiology.

002. Surgical approach to pleural mesothelioma: is pleurectomy the best choice?

Objective There is an opinion that extrapleural pneumonectomy (EPP) is the radical treatment option for locally advanced malignant pleural mesothelioma (MPM). In this report we evaluated the hypothesis that lung-sparing pleurectomy-decortication (LSPD) can be the procedure of choice in locally advanced MPM as it offers at least as good oncological results as EPP with reduced early postoperative complications and risk.