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In this large, randomized, placebo-controlled trial, a quadrivalent vaccine (including human papillomavirus types 6, 11, 16 and 18) given at day 1, month 2, and month 6 was associated with a significant reduction in the occurrence of cervical intraepithelial neoplasia. No beneficial effect was observed on prevalent lesions. The prevention benefit for incident lesions associated with HPV-16 and HPV-18 appears to increase with time.
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Human papillomaviruses are an important cause of genital warts and cervical cancer. In this large, randomized, placebo-controlled trial, a quadrivalent HPV vaccine given at day 1, month 2, and month 6 was found to significantly reduce the occurrence of cervical intraepithelial neoplasia and vulval or vaginal perianal lesions. No beneficial effect was observed on prevalent lesions. The benefit for prevention of incident lesions associated with HPV-16 and HPV-18 appears to increase with time.
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This study offers persuasive evidence of a strong association between exposure to or oral infection with the human papillomavirus and oropharyngeal cancer. The data indicate that sexual behaviors can spread the virus to the oral cavity. The use of tobacco, alcohol, or both did not strengthen the association between exposure to HPV and oropharyngeal cancer. Among patients who had no evidence of exposure to HPV, however, tobacco and alcohol use were strongly associated with oropharyngeal cancer.
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In 1993, the Netherlands established a reporting procedure for euthanasia and physician-assisted suicide, and most physicians who followed the guidelines were not prosecuted. Euthanasia and physician-assisted suicide were not officially legalized until a law was passed in 2002. According to surveys of physicians conducted from 1990 through 2005, euthanasia and physician-assisted suicide have remained uncommon, and the rates declined modestly after the practices were legalized.
A previously healthy 59-year-old man was admitted to this hospital with fever, weight loss, and painful swelling of both eyes and the right ear. Six weeks earlier, headache and fever had developed, followed by pain in the neck, pain and swelling of the eyes, and pain in the right ear; symptoms did not respond to antibiotic therapy. Laboratory studies on admission disclosed an elevated erythrocyte sedimentation rate and anemia. A diagnostic procedure was performed.
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