Proffered Papers 10.30–11.15 Monday 15 September 2003

Introduction  Colposcopy Quality Standards state that more than 85% of excisional biopsies should show CIN 1 or worse. Data from the National KC65 reports show a large difference between units (50% to 100%). This study investigates the reasons for failure to meet the standard.
Methods  A review of 1158 consecutive new and 1043 follow-up colposcopy examinations from a colposcopy database in East Somerset. Patients were treated at the time of initial examination if there was a clinically significant lesion, or at follow-up depending on the results of investigations.
Results  Only 59% of excisional biopsies showed CIN 1 or worse. The possible reasons for failure to meet the standard were explored. Possible explanations explored are erroneous colposcopy, false negative histology, and false positive cytology. The cytology–histology correlation was compared between excisional and directed biopsies, and between the two local cytology screening departments.
Conclusions  The collection of meaningful national data has more to do with careful definition than clinical practice or data collection.     

Association of Self-perceived Body Weight Status with Dietary Reporting by U.S. Teens*

Objective: Children's self perception of body weight and the medical definition of obesity show poor correlation. This study examined the independent associations of body mass index (BMI) and self-perceived weight status (considered self over-, under-, or right weight) with food reporting, nutrient intake estimates, and biomarkers of dietary exposure. Research Methods and Procedures: Dietary (one 24-hour recall), anthropometric, and biochemical data were from the third National Health and Nutrition Examination Survey (1269 boys and 1385 girls, ages 12 to 18 years). Sex-specific multiple regression analyses were used to determine the association of BMI and self-perceived body weight status with reported intakes of energy, macronutrients, low-nutrient-dense foods, micronutrients, and serum concentrations of selected vitamins and carotenoids. Results: Reported intakes of energy, macronutrients, number of eating occasions, percentage of energy from low-nutrient-dense foods, likelihood of meeting the standard of intake of micronutrients, and biomarkers were not different among boys and girls who perceived themselves as overweight relative to those who perceived themselves at the right weight (p > 0.05). In boys, BMI was a negative predictor of percentage of energy from low-nutrient-dense foods (p = 0.004) and intake of ascorbic acid (p = 0.04). BMI was inversely related to serum concentrations of most carotenoids (p ≤ 0.002). Discussion: Perceiving oneself as overweight was not associated with reporting of low-nutrient-dense foods, macronutrients, micronutrients, and biomarker status; BMI, however, was a significant predictor of several outcomes.     

Dopamine Transporter Genotype as a Risk Factor for Obesity in African-American Smokers

Objective: To assess the association between a polymorphism related to dopamine function, dopamine transport (SLC6A3), and obesity in smokers. Research Methods and Procedures: Logistic regression was used to assess the relationship between this genetic polymorphism and obesity (body mass index ≥ 30 kg/m²) from a sample of 510 smokers who smoked at least 10 cigarettes per day and who were participating in a study designed to examine genetic and nongenetic predictors of response to a pharmacological treatment. Results: The likelihood of obesity in African Americans (N = 90) with the 10/10 SLC6A3 genotype was 5.16 times that of African Americans with 9/9 or 9/10 SLC6A3 genotypes (odds ratio = 5.16, confidence interval = 1.60 to 16.65). There was no association of the SLC6A3 genotype with obesity for non-Hispanic whites (N = 420). Discussion: These results suggest that variants of the dopamine transporter gene may be related to obesity in African-American smokers. Possible mechanisms responsible for the association between dopamine transport and obesity in African-American smokers are discussed.     

Systematic evaluation of the adrenocortical function in patients with paracoccidioidomycosis

Limited cortisol response to ACTH stimulation has been documented in 22 to 48% of patients with paracoccidioidomycosis (PM). Different approaches to interpret the test and inadequate selection of patients preclude an accurate appraisal of the actual incidence of adrenal insufficiency in PM. Rapid cosyntropin (ACTH) stimulation tests were performed in 38 consecutive patients (9 with the localized and 29 with the disseminated form of PM) and 40 normal controls. Subnormal cortisol responses to ACTH (60 minutes post-ACTH values below 455 nmol/l, 95% confidence limits) were found in only 4 patients (14%) with disseminated PM. If a retrospective sample of 6 patients studied previously (in whom tests were indicated due to clinical suspicion of Addison's disease) were included, or if the absolute cortisol increment above baseline was used for interpretation, we would find figures closer to those previously reported (23 and 24%, respectively). These data reflect that non-systematic evaluation or selection of a substandard criterion to interpret the test overestimates the frequency of adrenocortical insufficiency in PM.