© 1999 Canadian Medical Association
Invasive cervical carcinoma is now one of the illnesses used to define AIDS cases. In a study of almost 400 Canadian women with HIV infection, Catherine Hankins and colleagues found human papillomavirus (HPV), thought to be the cause of invasive cervical carcinoma, in almost 70% of the women and in 91% of those with cervical squamous cell dysplasia (page 185). HPV infection was more likely to be present in women with CD4 counts of less than 0.20 × 109/L, in younger women, in those who were not white and in those who did not consistently use condoms during sexual intercourse. These results add to the evidence that regular cytological screening of the cervix is essential for HIV-positive women.
Cancer registries around the world have begun to record a greater number of new cases of testicular carcinoma. Using Ontario's registry, Hannah Weir and colleagues have documented an overall increase in incidence of 59% since 1964, the greatest increase occurring in men 15 to 29 years old (page 201). The usual suspects that might have artificially caused the rise (a new diagnostic test, enhanced screening, coding changes) are absent. The increase appears to be real, and this trend probably holds true for Canada as a whole. Laurence Klotz explores candidate causes, including the presence of estrogen and estrogen-like substances in the environment (page 213).
Now is the time of year when many of us in northern climes head south and when medical journals, CMAJ included, seem obliged to remind us of the various microbes and parasites that await us. In Canada in 1997, 1036 of us came back with malaria and many more probably suffered with the disease while travelling. Claudia dos Santos and associates interviewed travellers in the departure lounge at Pearson International Airport who were awaiting flights to India (page 195). Although two-thirds thought malaria was a serious problem and over half had sought pretravel medical advice, only 31% intended to use chemoprophylaxis and only 7% had been prescribed a recommended drug regimen. Dick MacLean and Brian Ward comment on the seriousness of this problem and urge physicians to provide good advice from appropriate sources, including Web sites (page 211).
Slow-reacting substance, discovered in 1940 and later identified as a leukotriene, causes prolonged constriction of smooth muscle. It has long been suspected as having a role in asthma. The past year has seen the release of a new class of commercial products for the treatment of asthma, the antileukotrienes. Paolo Renzi provides a detailed review of these new agents and their possible clinical role in asthma (page 217). In an accompanying editorial, Paul O'Byrne reviews the development of these drugs and cautions that antileukotrienes are unlikely to replace low-dose inhaled corticosteroids as the preferred treatment for mild, persistent asthma (page 209).