The natural history of cervical cryosurgical healing. The minimal effect of debridement of the cervical eschar [see comment

BACKGROUND: Cryosurgery is a favored treatment method for cervical intraepithelial neoplasia (CIN) among family physicians, in part because it is inexpensive and requires the least technical training and skill. Although cervical cryosurgery has been used for more than 30 years, the natural history of the postprocedure process has never been described. The primary purpose of our study was to describe the natural history of the healing process after cervical cryosurgery. A secondary purpose was to determine the effect of mechanical debridement of the cervical eschar on the symptoms of healing. METHODS: We conducted a prospective multicentered trial in which women who had a histologic ally documented CIN lesion underwent cervical cryosurgery. Forty-six women were randomized to undergo eschar debridement at 48 hours after cryosurgey, and 38 women received standard care. All women were followed up and given preweighed sanitary pads for hydrorrhea (watery discharge) collection and a diary to record the severity and number of days of odor, pain, cramping, and hydrorrhea that were experienced. RESULTS:The average total amount of hydrorrhea or discharge was 288 g, which required using an average of 41 sanitary pads during a period of 12.4 days. The duration of odor was 8.9 days, and the pain and cramping experienced after cryosurgery lasted 4.7 days. Women who were obese had greater hydrorrhea and pad usage than nonobese women. Debridement of the cervical eschar did not significantly change the signs and symptoms of healing after cryosurgery. CONCLUSIONS: There are significant symptoms patients experience after cryosurgery that are not ameliorated by debridement. The expectations of the cryosurgical healing process should be disclosed to women before the procedure.     

Colposcopy practice and training in family practice residency programs.

BACKGROUND: The potential growth of colposcopy as a family medicine procedural skill is directly related to the training currently offered to family practice residents. To define whether these skills are being adequately offered to physicians who want to perform this procedure for their patients, a study was designed to investigate the current status of colposcopy practice and training in family practice residency programs. METHODS: A 16-item survey sent to 356 family practice residency directors in the United States included items concerning colposcopy practice, training, educational programs and strategies, colposcopy coordinator educational background, and colposcopic resource materials and equipment. RESULTS: Surveys were returned from 204 (57 percent) family practice residencies. Colposcopy was performed at 45 percent of the residencies that responded. Ninety-six percent of the respondents who did not perform colposcopy believed colposcopy is a procedure that should be performed by family physicians. Clinical teaching and supervision was the most common method of resident training (74 percent). Colposcopy training coordinators were usually family physicians (72 percent), primarily trained by gynecologists. Assistance with implementing a colposcopy training program was requested by 85 percent of those programs presently not performing colposcopy. CONCLUSIONS: This study indicates that there are opportunities for further development of colposcopy practice and training in family practice residencies.     

An indirect fluorescent antibody test for the detection of Cytauxzoon-like organisms in experimentally infected cats.

Antiserum to feline Cytauxzoon-like parasites was used in conjunction with labeled rabbit antisera to feline globulins to detect the presence of Cytauxzoon-like parasites in spleens of experimentally infected cats. Frozen spleen sections from 21 infected cats showed positively fluorescing masses within splenic veins and a diffuse scattering of discretely fluorescing cells in the red and white pulp. The distribution of fluorescence corresponded with the appearance of parasitized reticuloendothelial cells in histological preparations of spleen tissue. This indirect fluorescent antibody test consistently detected the presence of Cytauxzoon-like parasites in frozen spleen sections from experimentally infected cats.     

A study of parameters involved in alternating-current defibrillation

The findings from the research reported in this paper may be summarized as follows: Cardiac defibrillation is an electric current oriented phenomenon. There is a preferred cardiac axis for effective defibrillation. The cardiac preferred axis cannot be related easily to body surface electrode placement. More effective methods of defibrillation involve the use of endoesophageal or endotracheal electrodes rather than two body surface electrodes. Impedance measurements of the thoracic region and the heart indicate that low frequency alternating current is probably the most effective defibrillating stimulus. While direct current is effective, there is a greater risk of electrolysis than with alternating current.     

A Phase II study of celecoxib,gemcitabine, and cisplatin in advanced pancreatic cancer

Summary Background. Pancreatic cancer is amongst the most chemoresistant malignancies. Expression of the cyclooxygenase-2 (COX-2) enzyme plays a major role in tumor progression and resistance to therapy. A Phase II study was undertaken to determine the effect of gemcitabine by fixed-dose rate infusion (FDR), cisplatin and the COX-2 inhibitor, celecoxib, on the 6-month survival rate in patients with metastatic pancreatic cancer. Methods. The eligibility criteria included a pathologically or cytologically confirmed diagnosis of adenocarcinoma of the pancreas. No prior gemcitabine therapy was allowed. Patients received a combination of gemcitabine 1000 mg/m² over 100 minutes, cisplatin 35 mg/m² I.V. on days 1 and 8, and celecoxib continuously at a daily dose of 800 mg. Cycles were repeated every 21 days. Results. Twenty-two patients with metastatic pancreas cancer were enrolled (median age, 59.5 years; M:F, 13:9). The median number of cycles was 2 per patient. The median survival time was 5.8 months (90% CI, 3.6–7.6 months). The probability of survival at 6 months was 46% (90% CI, 27–62%). The major toxicity was neutropenia with grade 3 or 4 toxicities seen in 65% of patients. Conclusions. The addition of celecoxib to gemcitabine (by FDR) and cisplatin did not appear to increase activity of the chemotherapy doublet in patients with advanced pancreatic cancer. Celecoxib alone may not be sufficient to sensitize pancreatic cancer to the effects of conventional cytotoxic therapy.     

Limited English proficiency and breast and cervical cancer screening in a multiethnic population

OBJECTIVES: We examined the relationship between ability to speak English and receipt of Papanicolaou tests, clinical breast examinations, and mammography in a multiethnic group of women in the United States. METHODS: We used longitudinal data from the Study of Women Across the Nation to examine receipt of breast and cervical cancer screening among Chinese, Japanese, Hispanic, and White women who reported reading and speaking (1) only a language other than English, (2) another language more fluently than English, or (3) only English or another language and English with equal fluency. Logistic regression was used to analyze the data. RESULTS: Reading and speaking only a language other than English and reading and speaking another language more fluently than English, were significantly and negatively associated with receipt of breast and cervical cancer screening in unadjusted models. Although these findings were attenuated in adjusted models, not speaking English well or at all remained negatively associated with receipt of cancer screening. CONCLUSIONS: These findings suggest that language barriers contribute to health disparities by impeding adequate health communication.     

Resistance Training Improves Sleep Quality in Older Adults a Pilot Study

Older individuals, as a group, tend to experience difficulty sleeping compared to younger adults. Improving sleep in the elderly would have beneficial public health consequences. This study utilized 8 sedentary, older adults, 78.1 ± 3.1 years of age, who participated in a six-month long resistance training (RT) program. The Pittsburgh Sleep Quality Index (PSQI) was used to examine sleep quality, and a 1 repetition max test (1-RM) was used to determine upper (bench press) and lower (leg press) body strength. Total strength, defined as the sum of the bench press and leg press 1-RM results, was also reported. The training resulted in significant improvements (p < 0.05) in total (19%) and upper body (52%) strength and in sleep quality (38%). Future studies should examine the effects of strength gain/loss and time-of-day training on sleep quality.

Key Points

• Compromised sleep and deterioration of skeletal muscle mass and function are commonly found among the aged.
• Results show that RT led to improvements in upper and total body strength in older participants who trained three times per week in the morning.
• The resistance training led to improvements in sleep as measured by a self-report sleep questionnaire, the Pittsburgh Sleep Quality Index.
• The small sample size used, lack of control group, and the fact that the participants on average were characterized as “good ”sleepers at the study onset, necessitates that further investigation occur.
• We suggest that further research is required to explore the effects of RT performed at different times of the day as well as to determine the relationship between sleep gains or losses upon changes in sleep quality.

Key words: Chronic disease, resistance training, older participants, strength, sleep