METHODS OF FETAL HEART RATE MONITORING DURING LABOR

A review of the history of fetal heart rate monitoring is followed by detailed analysis of eight randomized, controlled trials and of a recent prospective study of electronic fetal monitoring compared with intermittent auscultation. No significant differences between the methods were reported in perinatal mortality rates, neonatal infection rates, and Apgar scores. Mixed results were reported for length of labor, maternal analgesic use during labor, maternal genital tract infection rates, umbilical cord pH values, and admissions to neonatal intensive care units. Auscultation was associated in two trials with a significantly increased rate of neonatal seizures. Electronic fetal monitoring was correlated with a significantly increased cesarean delivery rate in the first four trials, and with a significantly increased rate of operative delivery (forceps plus cesarean delivery) in three later trials. A decision tree is presented to assist the clinician in selecting the appropriate fetal monitoring method for a given client.     

Non-small cell lung cancer

Lung cancer stands as the most important malignant neoplasm in the United States because of its high prevalence, increasing incidence, high rate of mortality, and great potential for prevention through the control of cigarette smoking. The World Health Organization (WHO) classification of lung cancer identifies four major types: squamous cell carcinoma, adenocarcinoma, large cell carcinoma, and small cell carcinoma. These tumors are commonly divided into two groups based on differences in their biology and treatment: small cell (SCLC) and non-small cell carcinomas (NSCLC). This review analyzes NSCLC with a strong emphasis on the practical aspects of treatment. We give recommendations about smoking cessation and early diagnosis through screening of high-risk individuals. We review contemporary diagnostic and staging techniques in the context of the new international TNM system of staging. Subsequent discussions of treatment are based on this new staging system. We stress the pivotal role of surgery for the management of local disease, and in addition present the potential contributions of newer radiation therapy techniques. We examine chemotherapy in detail, including a review of the comparative activity of the available cytotoxic agents against NSCLC, the relative contribution of combination chemotherapy, and the role of surgical adjuvant treatment with either chemotherapy or immunotherapy. We advise that patients with NSCLC be treated under the aegis of modern clinical trials of new therapy whenever possible. When this is not possible, we recommend an individualized approach based on such factors as the patient's age, general state of health, cardiopulmonary status, psychosocial status, and personal system of values.     

Aggressive angiomyxoma with gastrointestinal communication: a case report

We report the imaging findings of an abdominal aggressive angiomyxoma, which communicated with the gastrointestinal tract. The literature on this rare tumor is reviewed.     

Exocrine pancreatic function in mediastinal teratomata: an aid to preoperative diagnosis?

The diagnosis of teratoma may be made by demonstration of high amylase content in fluid aspirated from anterior mediastinal lesions. In 2 cases of mediastinal teratoma proteolytic enzyme activity was evident at the time of operation. A diagnosis of mediastinal teratoma was aided in 2 subsequent cases by demonstration of elevated amylase activity in the aspirated fluid before definitive operation.     

Virtual real-time digital processing of hemodynamic data

At present, the majority of cardiac catheterization laboratories acquire and store hemo-dynamic data in analog form. To examine the possibility of performing complex analysis of digital data during the catheterization procedure, we examined whether virtual realtime digital (fast Fourier) analysis improves the accuracy of clinical data. We compared digital filtering of fluid manometry during right heart catheterization with 10-Hz and 250-Hz analog filters. Using the simultaneously acquired micromanometry as the “gold standard,” we found that analog filtering is associated with a greater error and time delay than digital filtering. This study demonstrates that digital hemodynamic data analysis performed during cardiac catheterization can improve the quality of data obtained during right heart catheterization, with the results available within seconds. More extensive use of computers in the cardiac catheterization laboratory may be useful for both clinical and research purposes. © 1992 Wiley-Liss, Inc.