Qualitative Analysis of the Lived Experience of Reproductive and Pediatric Health Care in the Military Health Care System.

Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System.

Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant.

Objective: Despite the widespread use of benzodiazepines during pregnancy and lactation, little information is available about their effect on the developing fetus and on nursing infants. The authors review what is currently known about the effects of benzodiazepine therapy on the fetus and on nursing infants.

Methods: A MEDLINE search of the literature between 1966 and 2000 was conducted with the terms "benzodiazepines," "diazepam," "chlordiazepoxide," "clonazepam," "lorazepam," "alprazolam," "pregnancy," "lactation," "fetus," and "neonates.

Effects of antimanic mood-stabilizing drugs on fetuses, neonates, and nursing infants.

Pregnancy presents a special problem to the clinician treating bipolar disorders in women. Since the first episode of mania typically occurs before the age of 30, many women in their prime childbearing years may be exposed to potentially teratogenic mood-stabilizing agents. This exposure may also continue for the nursing infant during lactation.

Attitudes of Colorado health professionals toward breast and cervical cancer screening in Hispanic women.

Background: A variety of economic, cultural, and communication barriers appear to be involved in breast and cervical cancer screening among Hispanic women. These barriers include culture-based embarrassment both for mammography and for Pap smears and fear and hopelessness concerning a diagnosis of cancer. Cost and access barriers are shared by low-income women from various ethnic and racial groups, as is a purported lack of physician referral.

Pulmonary embolization and infarction. An iatrogenic complication of transcatheter embolization of a cerebral arteriovenous malformation with polyvinyl alcohol sponge.

Transcatheter embolization therapy of vascular abnormalities is a well-accepted technique. It is particularly useful in the preoperative management of cerebral arteriovenous malformations, in which the risk of significant hemorrhage at surgery would otherwise be unacceptably high. A patient developed symptomatic pulmonary emboli and infarction following an uneventful embolization using polyvinyl alcohol particles.

MR imaging and HMPAO scintigraphy in conjunction with balloon test occlusion: value in predicting sequelae after permanent carotid occlusion.

Objective: Permanent occlusion of the internal carotid artery may be required for en bloc resection of a neck tumor or to treat certain aneurysms. The risk of ischemic infarct is usually assessed with carotid balloon test occlusion and concurrent distal arterial pressure measurement. However, up to 20% of patients who tolerate the test occlusion have delayed neurologic sequelae.

MR imaging of spinal cord and vertebral body infarction.

Purpose: To study the usefulness of MR in the evaluation of spinal cord infarctions and associated findings.

Materials And Methods: MR examinations of 12 patients (10 men and two women) were reviewed retrospectively. Onset of symptoms of spinal cord ischemia was abrupt in all patients; MR was performed 8 hr to 4 months after onset.

MR evaluation of CNS tumors: dose comparison study with gadopentetate dimeglumine and gadoteridol.

In phase II and III trials of gadoteridol (Gd-HP-D03A), a new nonionic, low-osmolar contrast agent, 40 patients with intracranial neoplasms underwent magnetic resonance (MR) imaging with experimental doses of 0.05-0.3 mmol/kg.

Cerebral ischemia: evaluation with contrast-enhanced MR imaging.

Eighty patients with a total of 82 ischemic lesions were examined with contrast-enhanced MR imaging 1 hr to 1 month after onset of symptoms. The studies were reviewed retrospectively to determine the presence of arterial enhancement and the patterns of parenchymal enhancement. Arterial enhancement was often detected on the initial MR examination (45%), was frequently demonstrated in cortical infarction (86%), in some cases preceded the development of signal changes on T2-weighted images, and resolved by 11 days.

MR imaging of Hippel-Lindau disease: value of gadopentetate dimeglumine.

Hippel-Lindau disease is an autosomal dominant disorder characterized by tumors of the central nervous system and abdominal viscera. Frequent multisystem radiologic evaluation of persons at risk is desirable. Twenty-seven patients with Hippel-Lindau disease or a family history of the disease were examined with both unenhanced and gadopentetate dimeglumine-enhanced magnetic resonance (MR) imaging to study the usefulness of the contrast medium in the evaluation of these patients.

MR imaging of cerebral ischemia: findings in the first 24 hours.

MR changes of cerebral ischemia have been shown to occur as early as 1-2 hr after vessel occlusion in experimental models of stroke. However, the MR findings in the early stages of ischemic stroke in the clinical population have not been well established. We studied 41 lesions in 39 patients in whom MR was performed within the first 24 hr after onset of ischemic symptoms.

Magnetic resonance imaging and computed tomography in pediatric head and neck masses.

Fifty-three magnetic resonance imaging (MRI) and 25 computed tomography (CT) studies of 53 head and neck masses in pediatric patients were reviewed retrospectively. All lesions had pathologic proof except for 2 metastatic and 2 recurrent lesions, which only had prior pathologic confirmation at their primary sites. These included 12 malignant tumors, 23 benign tumors, 6 inflammatory masses, and 12 congenital lesions.

Neoplastic vs inflammatory meningeal enhancement with Gd-DTPA.

We studied 40 consecutive patients clinically suspected of having meningeal disease, in whom both Gd-diethylenetriamine pentaacetic acid (DTPA)-enhanced magnetic resonance (MR) examinations and CSF or surgical pathologic samples were obtained. The MR examinations were retrospectively reviewed for the presence of abnormal meningeal enhancement, as well as pattern and site of enhancement. The MR findings correctly correlated with pathology results in 15 of 19 patients with suspected tumor involvement (including one true negative) and in 18 of 21 patients with suspected inflammatory meningeal conditions (including 2 true negatives).

Techniques for lower-limb angiography: a comparative study.

Three separate variables--volume of contrast material, site of contrast material injection, and arterial inflow occlusion--were tested in a prospective, randomized fashion in 52 patients to determine the best technique for lower-limb angiography. Twelve patients received 30 and 60 mL of contrast material injected at the level of the external iliac artery (EIA), 20 patients received 60 mL injected at the level of the EIA with and without inflow occlusion, and 20 patients received 120 mL injected at the level of the aortic bifurcation and 60 mL injected at the level of the EIA. A total of 104 angiograms were obtained, two in each patient.

Cerebral ventriculitis: MR findings.

Cerebral ventriculitis is an uncommon site and manifestation of infection of the central nervous system. We report the magnetic resonance findings in two patients with cytologic and CSF culture proof of ventriculitis. The findings included abnormal signal intensity of the ependyma and CSF on T2-weighted images.

MR imaging of basilar artery occlusion.

We studied six patients with basilar artery occlusion using magnetic resonance imaging. Two patients also had arteriography. All had signs consistent with pontine infarction; three had a "locked in" syndrome.