Insurance and education determine survival in infantile coarctation of the aorta

Health outcomes are determined by case severity, physician decisions, and patient variables. In a population-based study between 1981 and 1989, 103 cases of infant coarctation of the aorta were diagnosed before one year of age. The goal of this study was to determine whether patient race, gender, income, and insurance status had effects on outcome of coarctation of the aorta that were distinct from the effect of case severity. Survival of infants with coarctation of the aorta, a common congenital cardiovascular malformation, is associated with greater maternal education and with having any health insurance but not with measures of severity. Infants without health insurance are 12.8 times more likely to die than infants with any health insurance. Fifty-five percent of all deaths in infant coarctation occur prior to surgical treatment. One-third of deaths occur without diagnosis. Outcome measures require knowledge of the entire population and of insurance status to inform policy.     

Endometrioid carcinoma of the oviduct

Endometrioid carcinoma is a malignant tumor which microscopically resembles endometrial adenocarcinoma, but arises from extrauterine sites, most commonly the ovary. Although its association with endometriosis has received considerable discussion, it appears that most of the malignant endometrioid tumors arise de novo. We present a case of endometrioid carcinoma which is outstanding for its primary site in the oviduct and for its histologic appearance, which incorporated a close interplay between both stromal and epithelial elements. The neoplasm was found incidentally, when the woman presented with postmenopausal bleeding due to adenomatous hyperplasia of the endometrium. The patient presented with a stage I, grade I tumor which did not invade the wall of the oviduct. Twelve years following a TAH-BSO and postoperative radiation, the tumor recurred, requiring additional surgery and chemotherapy. The patient is currently disease free, 2 years from her recurrence.     

Amenorrhea in an ovulatory woman despite a normal uterine cavity: case report

A 35-year-old nulliparous woman came to us for treatment of amenorrhea. Evaluation demonstrated normal ovulation with appropriate results of sequential endometrial biopsies during the luteal phase. The only abnormality found was an elevated serum level of follicle-stimulating hormone in the early follicular phase, and it is hypothesized that this somehow leads to atrophy of the endometrium without shedding.     

An ultrasonographic study of Peyronie's disease

A study was undertaken to determine the usefulness of ultrasonography as an investigative tool, and its role in deciding the management of Peyronie's disease. Fifteen patients with Peyronie's disease were studied by ultrasonography. The plaque could be demonstrated in all patients. The dimensions of the plaque varied from less than 1 cm to more than 7cm in length and 2-4mm in thickness. The disease was active in 26% of the patients, as indicated by the presence of hypoechoic areas around a central region of hyperechoism. Ultrasonogram was more accurate than clinical assessment in delineating the extent of lesions. In one-third of the patients, sonography demonstrated the plaques to be more extensive than had been detected by clinical examination. Calcification and activity of disease (which are clearly defined by ultrasonogram) are determining factors in the management of Peyronie's disease. This information allows the surgeon to select the modality of treatment, the timing of surgery and extent of excision. Thus, ultrasonography plays a vital role in the preliminary investigation and management of Peyronie's disease.     

Sex differences in the practice patterns of recently trained obstetrician-gynecologists

Sex differences in practice patterns, as modified by family roles, are investigated in a national survey of 1420 active obstetrician-gynecologists who graduated from medical school between 1974 and 1979. Women are more likely than men to be practicing in multispecialty groups, and men are more likely than women to be practicing in obstetrics-gynecology partnerships. On average, men and women report working over 60 hours per week. In all practice arrangements except academic medicine, women work fewer total hours per week, although the differences are small and translate into significantly fewer patient encounters than men in only two practice arrangements: partnerships and multispecialty groups. When marital status and presence of children under age 18 are controlled, significant sex differences in hours worked remain only for married respondents with children. Family roles have an opposite effect on hours of work reported by men and women, decreasing the number of hours worked by women and increasing the number worked by men.     

Parathyroid carcinoma: two new cases--diagnosis, therapy, and treatment

Carcinoma of the parathyroid gland is a disease only rarely encountered in clinical practice. As most of these tumors retain the ability to manufacture active parathyroid hormone, most patients with the disease present with hypercalcemia, many times symptomatic. Since the tumor accounts for only 0.5% to 4.0% of cases of primary hyperparathyroidism, the diagnosis of parathyroid carcinoma may be unsuspected and delayed. The clinical index of suspicion should be elevated if there is a palpable neck mass, an exceptionally high serum calcium level, and/or recurrence of hypercalcemia following surgery. We review two patients with parathyroid carcinoma who presented with hypercalcemia. In both, the diagnosis of malignancy was made only after microscopic examination of the operative specimen. Surgery consisted of wide local excision in both cases; radiation therapy was administered in one. Postoperative disease-free status is now 23 and 37 months. One of the patients had a history of radiation therapy to the larynx 20 years prior to the development of parathyroid carcinoma. Also reviewed in this paper are the clinical and histopathologic criteria for making the diagnosis of parathyroid carcinoma and the therapeutic approaches and prognosis of this unusual tumor.     

The importance of laparoscopic coagulation of mild endometriosis in infertile women

To evaluate the effect of fulguration of endometriotic implants in patients with mild endometriosis, we divided 123 patients into two groups: (A) patients whose endometriotic implants were coagulated, and (B) patients whose implants were left intact. In group A, 42 of 69 (60.8%) patients achieved a pregnancy within eight cycles following laparoscopic fulguration, in comparison with 10 of 54 (18.5%) patients from group B. The difference between this study and others is that all other infertility factors were meticulously corrected prior to laparoscopic treatment, and patients were allowed at least eight "normal" cycles before their endometriosis was treated. This is a report of 8 months' postoperative follow-up. The study was prospective and treatment was assigned randomly. We feel that laparoscopic fulguration significantly improves fertility in these carefully selected patients.