Prognostic indices in breast cancer are related to race.

African-American (AA) women have a higher mortality from breast cancer than Caucasians (C). This may be attributed to stage of disease at presentation, but specific prognostic factors are not well identified. We sought to identify prognostic factors in our database of early-stage (stage I and II) breast cancer from 1990 to 1999.

Metastatic endocervical adenocarcinoma presenting as a virilizing ovarian mass during pregnancy.

Background: We report a case of metastatic endocervical adenocarcinoma that presented as a virilizing ovarian mass in a young pregnant woman and simulated a primary ovarian endometrioid tumor.

Case: A 34-year-old woman underwent cesarean delivery and right salpingo-oophorectomy at 34 weeks' gestation for a 32-cm androgen-producing ovarian mass. The ovarian tumor, initially interpreted as a primary ovarian endometrioid carcinoma, was demonstrated to represent metastatic endocervical endometrioid adenocarcinoma based on detection of human papillomavirus 16 (HPV-16) deoxyribonucleic acid in the tumor by in situ hybridization.

National estimates of mortality rates for radical pancreaticoduodenectomy in 25,000 patients.

Background: Recent publications suggest an inverse relationship between mortality rates in the Whipple procedure for periampullary cancer and hospital volume/teaching status.

Methods: The Nationwide Inpatient Sample database from 1988 to 1995, containing 24926 patients undergoing pancreatectomy for periampullary cancer, was used.

Results: The mean number of procedures per hospital per year was 1.

Preterm delivery and the severity of violence during pregnancy.

Objective: To determine the severity and consequences of physical violence during pregnancy among participants in a health department prenatal care coordination program.

Study Design: The prospective cohort study included all program participants from 1994 to 1996. Care coordinators screened participants for physical violence during pregnancy using a validated, systematic assessment protocol three times during prenatal care.

Starting a successful bariatric surgical practice in the community hospital setting.

Background: 3% of the population is morbidly obese and experience many associated medical problems. Surgical procedures have been shown to achieve sustained weight loss not attainable by other measures, lessening the co-morbidities. However, most general surgeons have been reluctant to expand their practice to include bariatric surgery.

Management of recurrent juvenile granulosa cell tumor of the ovary.

Background: Juvenile granulosa cell tumors of the ovary are a rare form of neoplasm that makes up less than 5% of ovarian tumors in childhood and adolescence. About 90% are diagnosed in stage I with a favorable prognosis. More advanced stages (FIGO stages II--IV) have a poor prognosis.

Severity, manifestations, and consequences of violence among pregnant adolescents.

Purpose: To examine the severity, manifestations, and consequences of prenatal violence among adolescent and adult participants in a county health department prenatal care coordination program.

Methods: The prospective cohort study design included all Medicaid-eligible program participants from 1994 to 1996. Care coordinators screened participants for prenatal violence using a validated, systematic violence assessment protocol at three times during pregnancy.

Left-side preference in carotid endarterectomies.

Although the incidence of carotid atheromatous disease is presumably equal between the right and left carotid arteries, right and left carotid endarterectomies (CEs) may not be performed with equal frequency on the two sides. This study sought to examine whether right and left CEs are performed with equal frequency and whether there are any differences in outcome between these groups. Detailed chart review was performed on all CEs performed from 1979 through 1998 at our institution, and those lacking side data were excluded.

Abdominal sacral colpopexy for massive genital prolapse.

Objective: A retrospective study to determine the success and complications of abdominal sacral colpopexy in correcting massive genital prolapse over an 8-year period between September 1989 and January 1997.Methods: The charts were reviewed for 3 patients with massive procidentia and 15 patients with symptomatic posthysterectomy vaginal vault prolapse, who desired preservation of sexual function and underwent abdominal sacral colpopexy with Marlex mesh at two community teaching hospitals.Results: In 16 of the 18 patients, one or more concurrent procedures were performed at the same time, including three Burch colpocystourethropexies and one Raz bladder neck suspension, which successfully controlled urinary stress incontinence.

A randomized trial of intravaginal nonoxynol 9 versus oral metronidazole in the treatment of vaginal trichomoniasis.

Objective: This study was undertaken to investigate the efficacy of nonoxynol 9 suppositories in the treatment of vaginal trichomoniasis.

Study Design: In this prospective comparison trial 46 women with documented motile trichomonads found on a wet preparation were randomly assigned to one of two treatment arms: (1) a single oral dose of 2 g metronidazole and (2) a single 150-mg nonoxynol 9 suppository placed intravaginally for 3 consecutive nights. Cure was determined by a repeated wet preparation examination.

Treatment of vaginal dysplasia: just a simple loop electrosurgical excision procedure?

We report a case of sigmoid perforation, peritonitis, and adult respiratory distress syndrome after a loop excision procedure for carcinoma in situ of the cervix and dysplasia of the vagina. Treatment of vaginal dysplasia with loop excision is potentially dangerous. Safer methods of management include carbon dioxide laser, topical 5-fluorouracil, and fulguration.

Panniculectomy to facilitate gynecologic surgery in morbidly obese women.

Objective: To determine whether abdominal panniculectomy done in conjunction with pelvic surgery in morbidly obese women is safe and useful.

Methods: Twenty morbidly obese women had excision of large abdominal panniculi in conjunction with pelvic surgery at New Hanover Regional Medical Center between November 1994 and September 1998. Panniculectomy was to improve surgical exposure and to decrease the incidence of wound necrosis, infection, and dehiscence among those high-risk women who all had chronic intertrigo in the skin folds under their panni.

Radiation-induced bronchial stenosis: a new cause of platypnea-orthodeoxia.

Platypnea-orthodeoxia is encountered in a variety of cardiac, pulmonary, and hepatic disorders. We report its occurrence in a 59-year-old man who had had combined external-beam and high dose-rate iridium brachytherapy for a stage I non-small-cell carcinoma of the right upper lobe 2 years earlier. The post-radiation course was complicated by a severe radiation bronchitis; the onset of platypnea-orthodeoxia signalled the development of severe bronchial stenosis that was transiently relieved, initially by dilatation, and later by stent placement, though the patient ultimately died of a pulmonary hemorrhage.

Station and cervical dilation at epidural placement in predicting cesarean risk.

Objective: To compare station and cervical dilation at the time of epidural placement for predicting cesarean delivery risk.

Methods: This prospective cohort study included 275 women in labor with live, singleton fetuses at term in vertex presentations. We excluded women with preeclampsia or previous cesarean deliveries.

Uterine and ovarian conservation in advanced small cell carcinoma of the ovary.

Background: The decision to recommend removal or conservation of a normal ovary and uterus in a young woman with advanced ovarian cancer is difficult and controversial.

Case: A 21-year-old patient with a large-cell variant of small-cell carcinoma of the ovary stage IIIc underwent optimal debulking surgery with preservation of the normal appearing uterus and opposite adnexa followed by aggressive multi-agent chemotherapy. She is menstruating normally and is free of disease, more than 2 years since completion of chemotherapy.

Improving detection of violence among pregnant adolescents.

Purpose: The purpose of this study was to determine whether a systematic assessment protocol could increase reporting of violence among pregnant adolescents compared with a routine prenatal assessment. This study also sought to examine issues related to violence assessment among maternity care coordinators.

Methods: The Maternity Care Coordination (MCC) program in a health department prenatal clinic in North Carolina routinely screened all clients for violence at their first visit.

Assessing for violence during pregnancy using a systematic approach.

Objectives: The purpose of this study was to determine whether a systematic, multiple assessment protocol could increase reporting of prenatal violence compared with a one-time routine assessment.

Method: In 1994, the Maternity Care Coordination (MCC) program in a health department prenatal clinic in North Carolina implemented a concise, systematic assessment protocol on all 384 women who enrolled in the program from April 1994 to April 1995. The protocol assessed for violence at three times during pregnancy using the direct question, "Have you been hit, slapped, kicked, or hurt during this pregnancy?" To determine the effectiveness of the system, we retrospectively examined the 1991-1993 MCC records (n = 1056) in which the care coordinators routinely screened all clients for violence at their first visit only.

Effect of MgSO4 on heart rate monitoring in the preterm fetus.

Objective: To evaluate in a controlled, blind fashion, using both subjective and objective criteria, whether MgSO4 is associated with clinically significant changes in fetal heart rate monitoring.

Study Design: Fetal heart rate tracings were prospectively collected before and after MgSO4 loading in 50 preterm labor patients. Three obstetricians, blind to treatment status, graded the tracings using both subjective and objective criteria.

Persistent paralysis after prolonged use of atracurium in the absence of corticosteroids.

Neuromuscular blocking agents (NMBAs) are often used for patients requiring prolonged mechanical ventilation. Reports of persistent paralysis after the discontinuance of these drugs have most often involved aminosteroid-based NMBAs such as vecuronium bromide, especially when used in conjunction with corticosteroids. Atracurium besylate, a short-acting benzylisoquinolinium NMBA that is eliminated independently of renal or hepatic function, has also been associated with persistent paralysis, but only when used with corticosteroids.

Poor hospital documentation of violence against women.

Objective: This study sought to determine if violence against women is accurately documented in the trauma registry, and if poor documentation in the medical record is associated with incorrect coding in the registry.

Design: Retrospective cohort study.

Materials And Methods: We identified women aged 15 to 49 in the trauma registry of a regional medical center who had unintentional and intentional injuries over three years, and retrospectively reviewed their medical records to verify registry coding.

Factors affecting number of prenatal care visits during second pregnancy among adolescents having rapid repeat births.

Purpose: To examine factors associated with the number of prenatal care visits during second pregnancy for adolescents having a short interval between pregnancies.

Methods: The sample includes all adolescents aged 13 to 17 years whose first pregnancy resulted in a birth at a regional medical center in southeastern North Carolina from January 1983 to December 1989 and who had a repeat pregnancy within 24 months which resulted in a birth. We abstracted data from medical records and birth certificates.

The dementia syndromes. Distinguishing their clinical differences.

Dementia is one of the most devastating illnesses that affect the elderly. The progressive decline in memory, judgment, intellectual function, and adaptive ability places an immense burden on families, healthcare providers, and communities. Because advancing age is the leading risk factor for most types of dementia, the prevalence of this tragic disorder will increase as the population ages.

Interpreting digoxin concentrations.

In all cases, clinical assessment of the patient is the most critical factor in determining dose and interpreting concentrations. When done accurately, laboratory assessment of drug concentrations represents only one source of information. Serum concentrations must be taken into account along with all other relevant clinical data before one can arrive at appropriate management decisions.