Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed?

Transbronchial needle aspiration has emerged as a key technique for sampling mediastinal adenopathy but variable yields are reported. To determine the number of aspirates needed to optimize yield, we prospectively studied transbronchial needle aspiration and the sequential effect of each successive specimen on diagnostic yield in 79 patients with known or suspected lung carcinoma and mediastinal adenopathy. A total of 451 aspirates were performed in 79 patients (mean, 5.7 aspirates per patient; range, 2-13) with 45 cases (57%) positive for malignancy. A cytologically positive transbronchial needle aspiration occurred with the first aspirate in 42% of patients in whom this procedure established mediastinal nodal involvement. All positive results were achieved with seven or fewer aspirates. Similar yields were obtained for small cell and non-small cell lung cancer after seven aspirates. Rapid on-site specimen cytologic evaluation was used in 55 of 79 cases (70%), with a positive diagnosis obtained in 39 of 55 cases (71%) with on-site evaluation compared with six of 24 cases (25%) performed without on-site evaluation. The data suggest there is a plateau in yield after seven transbronchial needle aspirates, which may be sufficient to obtain an optimal yield in assessing patients with lung cancer and mediastinal adenopathy.     

Adolescent pregnancy outcomes at Queen Elizabeth Central Hospital,Malawi: a cross-sectional study

Malawi has a growing population with a high Maternal Mortality Ratio (MMR) of 439 per 100,000 live births to which adolescents contribute 25%. Current data suggests adolescent pregnancies in low resource settings are at an increased risk of both maternal and neonatal morbidity.ObjectivesThis study assessed the pregnancy outcomes amongst adolescents while using women from the early adulthood (20 – 24-year-old) and advanced maternal age (35 years old and above) groups as reference.MethodsThis was a cross-sectional study, carried out at the Chatinkha maternity (labour) and post-natal wards at QECH, and included all adolescents (10 – 19 years old) and women between 20 – 24 years old (early adulthood) and 35 years old or older (advanced maternal age), presenting in labor, at any gestational age ≥ 28 weeks or with a birth weight of 1000 grams or above.ResultsThe study found the prevalence of adolescent pregnancy to be 20.4% (N=5035) out of all the deliveries during the recruitment period. Sexually transmitted infections were proportionally higher in the adolescent group, with 12% testing HIV seroreactive and 10% syphilis seroreactive. Neonatal outcomes of birth asphyxia (3.5%), low birth weight (5%), prematurity (4.3%) and early neonatal death (4.3%) were not statistically different from the outcomes of the older age groups. The major causes of maternal morbidity were determined to be a high caesarean section rate of 31.9% and intrapartum diagnosis of urinary tract infection (7.4%), malaria (7.4%) and hypertensive disorders (14.5%).ConclusionsAdolescents are a significant proportion of the pregnant population in Malawi. These adolescents are at increased risk of some pregnancy and peripartum complications when compared to women of older age groups. However, our study determined that these outcomes appear to be more likely related to the peripartum care received and not solely specific to maternal age.     

Randomized field trial of vaginal douching,pelvic inflammatory disease and pregnancy

BACKGROUND: Several case-control studies have reported that women who use vaginal douche products are at increased risk for pelvic inflammatory disease. Women who douche regularly may do so for reasons related to their risk of acquiring a sexually transmitted infection, introducing confounding that is difficult to control in non-experimental studies. METHODS: We conducted a multicenter randomized field trial with a 1-year follow-up period. The study comprised 1827 women age 18-34, with no current indication of pelvic inflammatory disease, who were regular users of a douche product and who had been treated recently for a sexually transmitted bacterial infection or bacterial vaginosis. Women were randomly assigned to use either a newly designed and marketed douche product or a soft cloth towelette, and were resupplied with product at each bimonthly follow-up visit. We measured the occurrence of pelvic inflammatory disease using a combination of clinical and laboratory indicators. We also recorded pregnancy occurrence among participants. RESULTS: The risk of PID among women assigned to use the douche product, relative to that among women assigned to use the wipe product, was 1.05 (95% confidence interval = 0.57-1.9). Using an alternative, less sensitive definition of PID gave a risk ratio of 1.26 (0.62-2.6). The probability of becoming pregnant was 15% lower among women assigned to use a douche product, and 33% lower among women who douched more frequently (ratio = 0.67; 0.42-1.08). CONCLUSIONS: There was little or no indication of a greater risk of PID among women assigned to use the douche product. Douching may be related to a lower probability that a woman becomes pregnant.     

The role of stress,social support and age in survival from breast cancer

This study focused on the relationship of objective and subjective stresses to survival from breast cancer. The potential mediating roles of social support and age were also considered. This prospective study involved 208 white female breast cancer patients diagnosed between 1958 and 1960. At the time of diagnosis, subjects were interviewed regarding objective and subjective stress and social support present in the 5-year period preceding their diagnosis. Twenty years later, survival was calculated. The relationships between stress and survival were examined for three age groups: 15–45, 46–60, and 61 and older. Objective stress was related to survival for the oldest group while subjective stress was related to survival for the youngest group. Neither stress was related to survival for women aged 46–60. Social involvement was independently related to survival although it was not a mediator in the stress-survival relationship. Using the entire sample, stage of cancer at diagnosis was the best predictor of survival. However, when women aged 46–60 were eliminated from the analysis, stress and social involvement accounted for twice as much variance in survival as stage.     

Simplified outpatient lower extremity venography

A unit is discussed which employs a pair of matched silicon diode detectors to check the constancy of the output, beam quality, field flatness, and symmetry of teletherapy equipment. The unit has proven useful, but the long-term stability of the diode-amplifier system must be considered, because two years of experience has demonstrated significant sensitivity changes in the diodes.     

Does computer use affect the incidence of distal arm pain? A one-year prospective study using objective measures of computer use

Purpose  

To study how objectively recorded mouse and keyboard activity affects distal arm pain among computer workers.     

INFORM: integrated support for decisions and activities in intensive care

Summary Many medical decision support systems that have been developed in the past have failed to enter routine clinical practice. Often this is because the developers have failed to analyse in sufficient detail the precise user requirements, because they have produced a system which takes too narrow a view of the patient, or because the decision support facilities have not been sufficiently well integrated into the routine clinical data handling activities. In this paper we discuss how the AIM-INFORM project is setting out to deal with these issues, in the context of the provision of decision support in the intensive care unit.