Cervical surgery and preterm birth

Treatment of cervical intraepithelial neoplasia (CIN) greatly reduces the risk of cervical cancer. Treatment involves ablation or excision of the transformation zone of the cervix, most commonly using an electrosurgical excision technique known as LLETZ. However, the peak incidence of CIN occurs in young women, so if excision of a portion of the cervix has an adverse effect on pregnancy outcome, this might have a significant impact. This review discusses the methodology and findings of the published literature on the association between cervical treatment and preterm birth, and the clinical implications of these findings.     

Hyperthermic intraperitoneal chemotherapy in conjunction with surgery for the treatment of recurrent ovarian carcinoma

OBJECTIVES: To review experience of secondary surgical cytoreduction (SSC) with hyperthermic intraperitoneal chemotherapy (IPHC). METHODS: Eligible patients with ovarian cancer in whom pre-operative evaluation indicated that there was a good possibility that disease could be resected to < or = 5 mm underwent surgery followed by intraperitoneal perfusion of cisplatin (100 mg/m2) or mitomycin C (30-40 mg total dose) heated to 41-43 degrees C (105.8-109.4 degrees F) for 90 min. Data for analysis were extracted from retrospective chart review. RESULTS: Eighteen patients underwent surgery and IPHC between 9/02 and 3/05. Characteristics were median age 64 (37-77) years, mean prior laparotomies 1.4 (0-3), mean chemotherapy regimens 3.2 (0-7), mean time from initial therapy to IPHC 30.6 (1-88) months. Original histology: papillary serous 12, poorly differentiated adenocarcinoma 1, serous low malignant potential 2, mucinous 1 and mixed subtypes 2. 13 had recurrent disease and 5 had persistent disease following front-line therapy. 15 received cisplatin and 3 mitomycin C. The mean duration of surgery was 9.8 (5-16) h. The maximum dimension of residual lesions at the end of surgery prior to IPHC was nil (n=11), < or = 2 mm (n=4), < or = 5 mm (n=2) and < or = 10 mm (n=1). Mean time to return of bowel function was 7 (5-20) days and mean time to hospital discharge 11.5 (5-49) days. All patients developed CTEP grade 1 or 2 metabolic or hematologic toxicities. CTEP grade 3 or 4 metabolic toxicity occurred in 72% and a hematologic toxicity in 28%.There was one peri-operative death due to pulmonary embolus. Median progression-free interval was 10 months and median overall survival was 31 months. Improved outcome was significantly related to the size of residual disease prior to IPHC and postoperative chemotherapy. CONCLUSIONS: IPHC is a relatively well-tolerated procedure with the majority of the morbidity being related to associated surgery. When combined with SSC it has the potential to extend quality life in some patients with recurrent ovarian cancer and warrants continued research. Randomized studies are needed earlier in the course of the disease.     

Fetal diagnosis - obligations of the clinician. Case studies in the prenatal diagnosis of major heart abnormality

Fetal echocardiography allows for accurate diagnosis of major heart abnormalities by 16-18 weeks. The parents have up to 22 weeks to consider possible termination. What are the obligations of the clinician once an abnormality is found? Should only information be provided or is there a role in influencing the parents' decision? Two diverse examples are provided to discuss these questions. Mrs A., aged 40 years was noted at the 18-week and then the 20-week scan to have a fetus with a complete atrio-ventricular septal defect. In addition, the fetus had a Danny-Walker cyst. There was thickened nuchal folds and echogenic bowel all suggestive of a chromosomal abnormality. Amniocentesis was refused and the pregnancy continued. Mrs B., aged 34 years was noted at 19 weeks and again at 20 weeks to have a fetus with mild thickening of the walls of both the right and left ventricles. The flow patterns appeared normal. Despite a probable good outlook, the parents asked for a repeat scan at 22 weeks to allow them to consider possible termination. Despite a probable chromosomal abnormality, definite major cardiac and neurological abnormalities, Mrs A. refused karotyping and planned to proceed with the pregnancy. Mrs B., despite a probable good outcome for the fetus asserted pressure for us to prognosticate by 22 weeks. While non-directive counselling is the accepted norm, is that appropriate for all situations? Should one strongly influence Mrs A. to have an amniocentesis to confirm a probable Trisomy thereby allowing her to make a more informed decision? How reassuring can the clinician be to Mrs B. and if termination is sought should one counsel against that? Arguments for these positions are described, highlighting the difficulties faced by clinicians as they counsel parents often with incomplete information and in a setting of acute emotional distress.     

Survey of sibling and peer visitation policies in southern California hospitals

A survey of southern California hospitals identified current visitation policies and the rationale for the restrictions of siblings and peers. Questionnaires mailed to the nursing administrators of 212 hospitals having designated pediatric beds indicated that the majority allowed some form of sibling visitation. The rationales for restriction most frequently given were prevention of infection and spread of communicable disease. The results indicate a gap between sibling visitation research and the theoretical rationale given to support restrictive policies.     

The link between memory performance,self-assessment,and affective status

Abstract

To investigate the relationship between memory performance, self-assessment of memory, and affective status, 67 elderly females were administered a self-assessment memory questionnaire and multiple measures of affect and laboratory memory test performance. Canonical correlations indicated that the memory performance scores were not related to the affective measures nor to the scales of self-assessed memory ability. Affective status and self-assessment of memory skill were related, suggesting that investigations of memory performance which rely on self-assessment should also measure affective status.