Although the frequency of Factor V Leiden mutation appears to be significantly higher among preeclamptic women, the mechanism of pathogenesis and potential influence on perinatal outcomes is not yet well understood. Relatively high rates of HELLP syndrome among those with Factor V Leiden mutation suggest that this thrombogene mutation may play a significant role in hemostatic system activation. Our results suggest that the role of MTHFR polymorphism and other factors such as folic acid supplementation will require more extensive analysis in controlling worldwide morbidity and mortality associated with this important maternal condition.

There is now considerable concern that universal access to health care within realistic resource constraints requires some sort of cost-effectiveness analysis of given medical procedures and interventions. One such intervention is routine mammographic screening for breast cancer. Here, we report preliminary results from an ongoing project to conduct a systematic and comprehensive review and comparison of the published cost-effectiveness analyses of screening for the early detection of breast cancer. We examine 16 such studies, and compare two studies in detail to explain how differences in assumptions and in consideration of down-stream effects have caused the published results for apparently comparable breast cancer screening programs to span a broad range.

This study investigated the frequency of apolipoprotein E (apoE) alleles among women with severe pre-eclampsia. The presence of the three most common apoE alleles ( 2, 3, 4) was determined by polymerase chain reaction-restriction fragment length polymorphism in three groups of white women: non-pregnant healthy (n = 101), pregnant healthy (n = 52), and pregnant with a diagnosis of severe pre-eclampsia (n = 54). The frequency of apo 2 was highest among women with severe pre-eclampsia (16.6%) followed by non-pregnant women (12.9%), and those experiencing a healthy pregnancy (10.6%). The higher frequency of the apo 2 allele detected among women with severe pre-eclampsia suggests that apoE may play a role in the development of pre-eclampsia. (J Clin Pathol 1998;51:324-325) Keywords: apolipoprotein E; pre-eclampsia; gene polymorphism Apolipoprotein E (apoE) plays an important role in lipid metabolism, and women with preeclampsia have raised lipid concentrations. Therefore, we investigated the possible role of apoE in pre-eclampsia by determining the frequency of apoE alleles and genotypes using polymerase chain reaction (PCR) combined with restriction fragment length polymorphism (RFLP) analysis. Patients and methodsParticipants (207 white women) were drawn from an urban university department and assigned to one of three study groups depending on health status. The three groups included a healthy non-pregnant reference group (n = 101, blood donors) ranging in age from 18 to 62 years (mean, 37); a healthy pregnant 20-41 weeks' gestation (mean, 35.5) control group (n = 52) ranging in age from 17 to 41 years (mean, 26); and a study group of women with severe pre-eclampsia (n = 54) ranging in age from 18 to 45 years (mean, 28.8) who were between 25 and 38 weeks' gestation (mean, 32). The pre-eclampsia group comprised women who were diagnosed with severe pre-eclampsia at our department from 1 October 1996 until 1 September 1997 according to American College of Obstetricians and Gynecologists guidelines.

As the toll taken by breast cancer continues unabated, screening programs are widely perceived to play a critical role to improve diagnosis and successful treatment. Breast cancer screening programs are increasingly promoted to women; however, the economic implications of mass screening is a subject of much health policy debate. Cost‐effectiveness analysis is an economic methodology widely used to inform such decisions, yet there is a dearth of information available on the economic consequences of mass breast cancer screening. The authors evaluated nine breast cancer screening cost‐effectiveness studies that are based on computer simulations, observational trial data, or a combination of both. The results of these studies, conducted in the United States and other countries, indicate that the cost‐effectiveness of screening for breast cancer generally compares favorably with other expenditures in the health‐care field, although screening younger women does not appear to be as favorable. However, there is considerable variability in the methodology used and a need for more comprehensive research in this area.