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Malignant mixed müllerian tumors of the ovary. Report of 13 cases.

Thirteen patients with verified malignant mixed Müllerian tumor of the ovary treated in Denmark during the 7-year period 1981-87 were reviewed. Two patients had homologous and 11 patients had heterologous tumors. Four patients with early stage disease underwent radical surgery; 9 patients had stage III disease. Median survival for all 13 patients was 12 months. Six patients received platinum-containing cytotoxic therapy; 2 of these patients without measurable disease became long-term survivors (survival times 42+ and 92+ months, respectively) and 3 of the 4 remaining patients with evaluable disease obtained an objective remission.     

Management of elevated cholesterol levels by New Hampshire primary care physicians

While experts are reaching a consensus on the appropriate management of abnormal blood lipid levels, the attitudes and behaviors of practicing clinicians are not well defined. This study addresses the attitudes and management practices regarding blood lipids of a representative sample of family physicians and general internists in the state of New Hampshire as determined by a questionnaire mailed during late 1986. Physicians consider blood lipid testing to be important in adults, but vary widely in their idea of what levels represent high risk for coronary heart disease. Over 40 percent felt that cholesterol levels need to be 7.80 mmol/L (300 mg/dL) or greater to constitute a high risk for coronary heart disease for patients aged 40 to 59 years. In addition, physicians feel much less effective in managing lipid abnormalities than in managing hypertension. Family physicians and general internists did not differ significantly in behavior or attitudes. To implement new expert recommendations, substantial efforts will be required to convince physicians to adopt lower cholesterol levels as indicating high risk for coronary heart disease and to feel more effective in patient management.     

Should every patient undergo cardiac catheterization after myocardial infarction?

During the past few decades, management of patients with myocardial infarction has dramatically evolved. High-risk patients are now identified by a variety of noninvasive tests, and aggressive use of reperfusion strategies has improved clinical outcomes. Despite the benefits of reperfusion, only a few patients are eligible to receive thrombolytic therapy. Mortality rates among patients excluded from thrombolytic trials (15% to 20%) have been far greater than those eligible for treatment (3% to 10%). Because most deaths occur within the first few days of infarction, interventions designed to reduce mortality should be performed acutely. Immediate catheterization allows identification of high-risk anatomy that may benefit from surgery and allows coronary angioplasty to be performed as a reperfusion strategy (when appropriate). Furthermore, catheterization allows documentation of ejection fraction, vessel patency, number of diseased vessels, and residual stenosis, all of which have been predictive of prognosis. Conversely, frequently repeated noninvasive diagnostic tests are associated with increased cost, are generally performed in low-risk patients, and 60% to 80% of patients with myocardial infarction ultimately require catheterization anyway. It is possible that early catheterization and percutaneous transluminal coronary angioplasty when indicated may effectively risk stratify patients (eliminating the need for noninvasive testing), may reduce morbidity and mortality, and shorten the length of hospital stay.