Thrombosis at venous insertion sites after inferior vena caval filter placement

Color Doppler flow imaging or compression ultrasound (US) was used to prospectively determine frequency of thrombosis at 54 venous insertion sites (47 in common femoral veins, seven in right internal jugular veins) after percutaneous placement of Greenfield filters for interruption of the inferior vena cava. Fifty-one filters were successfully placed in 51 patients with a dilator set or a balloon angioplasty catheter. Nine focal thrombi were detected in the common femoral vein (19%) and one in the right internal jugular vein (14%). Use of dilators induced eight thrombi (24%), compared with two (10%) from balloon catheters. The left common femoral vein had a high frequency of thrombosis, regardless of dilation technique (five of nine). Of nine patients with acute common femoral vein thrombosis, four became symptomatic within 10 days after the procedure. Patients may remain asymptomatic or have delayed symptoms; thus, US is valuable for determining patients at risk of thrombosis of the common femoral vein.     

Therapy of non-preeclamptic hypertension in pregnancy

The poor perinatal outcome of pregnant women with chronic hypertension depends on their increased susceptibility to superimposed preeclampsia. There is no direct evidence that this is mediated by hypertension and reduced by antihypertensive treatment. In particular, the arterial lesions of the uteroplacental circulation in preeclampsia also occur in normotensive individuals and would be unusual types of pressure-induced injury. Thus, there is no compelling reason for treating hypertension below a threshold (170/110 mm Hg) above which maternal safety becomes the main concern.     

Organizational resources in support of patient education programs: relationship to reported delivery of instruction.

Two studies of patient education programs tested hypotheses regarding the relationship between structural, attitudinal, and resource variables and reported receipt of instruction by patients and delivery of instruction by providers. Three predictor variables--degree of structure for implementation, provider perception of reinforcement for doing patient education, and perceived payoffs from the program, were significantly related to measures of the dependent variable. Age of the program, administrator support for social change and staff support for the program, did not show significant relationships with receipt/delivery of instruction. Future studies might investigate: how coordinative functions are carried out rather than whether a coordinator for the program has been named, the relationship between financial condition of the hospital and ability to deliver patient education services, and the relationship between patient education resources and outcome variables such as health care services used and cost. Research about resources necessary to ensure adequate delivery of instruction to patients is as important as is research about resources necessary to ensure adequate delivery of instruction to patients is as important as is research about the design of instruction.     

Tumour cell activity markers in epithelial ovarian cancer: are biochemical and cytometric indices complementary?

Flow cytometry has enabled the objective assessment of cellular morphology and activity, which can also be biochemically evaluated by measuring products of cellular metabolism, such as cyclic 3'5' guanosine monophosphate (cGMP). Using paraffin-embedded formalin-fixed material obtained from the primary operation, an analysis of the correlation between nuclear ploidy and the proliferative index (PI) as quantified by flow cytometry with pre-treatment urinary cGMP was performed in 40 epithelial ovarian cancer (EOC) patients. The majority of the study group had advanced disease (28 FIGO III/IV) and residual disease (31). All but three (stage I) patients received single agent high dose cisplatinum as first-line therapy (100 mg m-2 x 5); in patients with evaluable disease there was a response rate of 64%. Thirty-one patients have died; the median survival of the study population being 27 months. There was a significant association between cGMP and PI. Significantly more aneuploid tumours had elevated PI values (P = 0.02). No variable predicted response. An initial univariate log rank analysis identified stage, the amount of residual disease, cGMP and PI as prognostic factors. Because of the interrelation between these and other factors and because PI did not conform to the proportional hazards model, a multivariate stepwise discriminant analysis was performed using survival at 36 months (the minimum follow-up for surviving patients) as the end-point. On the basis of this analysis, stage and residual disease were the most important prognostic factors, but cyclic GMP continued to have prognostic value even when these other factors were entered into the predictive model. However, the additional information gained has little clinical relevance.     

Perceptions of screening mammography among women aged 40–49

OBJECTIVE: The aim of this study was to survey women aged 40 to 49 to determine their perceptions of the benefits and the downsides of screening mammography for women in this age group, and the degree of support for targeting women aged 40 to 49 in the national BreastScreen program. METHOD: Telephone interviews were used in a two-stage survey of 200 women aged 40 to 49 from across Australia in 1997. Information that outlined some of the evidence for costs and effectiveness of screening in this age group was sent to the women after the first survey. RESULTS: Women saw both benefits and downsides of mammography screening in this age group. Although the proportion of women reporting downsides increased from (39%) to (69%), after reading the information most women (62%) still thought the benefits outweigh the downsides of offering a screening program to women aged 40-49 and the majority (66%) supported the notion of government funding for this. Most women agreed that women aged 40 to 49 have to be informed about all the advantages and disadvantages of screening before making a decision to attend. CONCLUSION: If women aged 40-49 were to be actively recruited to a government screening program, an information campaign should be undertaken that outlines the benefits and downsides of screening mammography to foster informed participation. IMPLICATIONS: Community views are a helpful contribution to debates about policy when existing data are ambiguous.