Analysis of censored and incomplete survival data using flowgraph models

Multi-state stochastic models are widely used to model stages of disease progression in survival analysis. This paper develops flowgraph models for data analysis in survival analysis. We illustrate these methods using data from a study of diabetic retinopathy consisting of 277 subjects with insulin-dependent (type I) diabetes mellitus (IDDM). These data were collected at the Eye-Kidney Clinic of the Barbara Davis Center for Childhood Diabetes at the University of Colorado Health Sciences Center.     

Breast cancer mortality among female radiologic technologists in the United States

We evaluated breast cancer mortality through 1997 among 69 525 female radiologic technologists who were certified in the United States from 1926 through 1982 and who responded to our questionnaire. Risk of breast cancer mortality was examined according to work history and practices and was adjusted for known risk factors. Breast cancer mortality risk was highest among women who were first employed as radiologic technologists prior to 1940 (relative risk [RR] = 2.92, 95% confidence interval [CI] = 1.22 to 7.00) compared with risk of those first employed in 1960 or later and declined with more recent calendar year of first employment (P for trend =.002). Breast cancer mortality risk increased with increasing number of years of employment as a technologist prior to 1950 (P for trend =.018). However, risk was not associated with the total number of years a woman worked as a technologist. Technologists who first performed fluoroscopy (RR = 1.69, 95% CI = 1.02 to 3.11) and multifilm procedures (RR = 1.87, 95% CI = 1.04 to 3.34) before 1950 had statistically significantly elevated risks compared with technologists who first performed these procedures in 1960 or later. The high risks of breast cancer mortality for women exposed to occupational radiation prior to 1950 and the subsequent decline in risk are consistent with the dramatic reduction in recommended radiation exposure limits over time.     

Cephalic vein cutdown for inserting indwelling subclavian vein catheters in gynecologic oncology patients

To decide on an alternate procedure for placement of central vein catheters other than percutaneous access of the subclavian vein, we conducted a study of 46 women who underwent placement of a central venous catheter utilizing the cephalic vein procedure at Ruby Memorial Hospital at West Virginia University in Morgantown. Of these patients, 96% had a successful placement of a catheter into the subclavian vein following dissection of the cephalic vein within the deltopectoral groove. There were no cases of pneumothorax or injury to the great vessels during the surgical procedure, which is a significant advantage for women who often have significant pleural effusions.     

Childhood Stressors and Coping Actions: A Comparison of Children and Parents’ Perspectives

At a time when many children and families are faced with enormous daily life hassles and major stressful events, it is crucial to understand issues pertaining to childhood stress and coping. The present study examined children and parents’ perceptions of childhood stressors and children’s coping actions. Findings reveal that children report higher stress levels than parents. The stressors identified by children range from peer related stressful situations such as being laughed at to internal factors such as lack of control, and major life events such as death of a loved one. Children and parents report a large range of coping actions with three predominant themes—cognitive, social, and emotional coping strategies. Implications for practice are discussed. This research was supported by a General University Research Program Grant from the University of Delaware.     

Spontaneous scrotal faecal fistula in an infant

A 2-month-old, full-term male presented with a left scrotal faecal fistula due to spontaneous bursting of an incarcerated inguinal hernia for 8 days, with complete decompression of the small bowel through it. Resection and end-to-end anastomosis of the engaged ileal loop was successfully done after incising the ring via the inguinal approach. Only two such cases have been reported in the world literature to date. Accepted: 26 April 1999     

Leptospirosis - an under-diagnosed clinical condition

Leptospirosis is a zoonotic disease caused by leptospiral spirochaete. Two cases in children are described presenting with hepatorenal dysfunction.     

Lingual thyroid: a review of 12 cases.

Twelve patients with lingual thyroid are reviewed. Two of these patients had a follicular carcinoma in the ectopic gland and both are well 5 and 16 years after treatment. The diagnosis is essentially clinical but confirmation may be made with a thyroid scan. Six patients were treated conservatively with thyroxine with good results. Six patients were treated by surgical excision, 2 undergoing autotransplantation of the excised gland into the anterior abdominal wall.     

Giant prostatic calculi

An unusual case of giant prostatic calculus associated with urinary incontinence is presented. The calculus was removed suprapubically and the postoperative course was uneventful except for continuing incontinence. An incontinence procedure was performed with satisfactory results.