Myomectomy as a pregnancy-preserving option in the carefully selected patient

Objectives: To present the indications for myomectomy during pregnancy and to discuss complications possibly related and unrelated to the procedure. Method and Results: A 33-year-old patient at 18 weeks of gestation underwent removal of a 1,570-gram symptomatic fundic myoma. Histologically the patient had a leiomyomatous neoplasm of uncertain malignant potential. The pregnancy was continued under sequential observation with magnetic resonance imaging and ultrasound. At 36 weeks of gestation a healthy girl with an upper extremity limb defect was born via cesarean section. Follow-up of the mother and the child was uneventful. Conclusions: Certain known risk factors in pregnant women with myomas can predispose to complications during pregnancy. Women with such risk factors or women who have failed medical therapy should be offered the option of undergoing myomectomy as a pregnancy-preserving procedure. Copyright (C) 2002 S. Karger AG, Basel

Influence of selected patient variables and operative blood loss on six-month survival following liver transplantation.

A group of 118 adults who underwent primary, orthotopic transplantation of the liver over a 4-year period served as the subjects of a detailed examination of their ability to survive the first 6 months as a function of their preoperative condition. As a result, a scoring system was developed empirically in an attempt to separate very high-risk from relatively low-risk patients. The scoring method is based on the high degree of correlation between survival probability and various patient characteristics. It allows for additional scoring to account for the dramatic effect of operative blood loss on the eventual outcome. The curve that best describes the relationship between patient scores and survival probability is sigmoidal in shape. Many patients will have scores located on the curve between the inflection points. They represent a group whose relative risk is difficult to estimate but for whom operative blood loss or the occurrence of surgical complications may prove particularly telling

“I don’t want to look sick skinny”: Perceptions of body image and weight loss in Hispanics living with HIV in South Texas

Objective: Obesity is rising in people with HIV (PLWH) and Hispanics. Both HIV and obesity are associated with cardiovascular disease morbidity and mortality. Our goal is to understand perceptions of body image and lifestyle in Hispanics with HIV to adapt interventions appropriately. Methods: We conducted semi-structured interviews with 22 Hispanic PLWH and 6 providers. Purposive sampling selected patient participants across weights and genders. Interviews were coded and analyzed using grounded theory, comparing perspectives between patients with and without obesity, and patients and providers. Results: Participants felt obesity and diabetes were “normal” in the community. Patients exhibited understanding of healthy diet and lifestyle but felt incapable of maintaining either. Traditionally Hispanic foods were blamed for local obesity prevalence. Five patients equated weight with health and weight loss with illness, and four expressed concerns that weight loss could lead to unintentional disclosure of HIV status. Participants with overweight or obesity expressed awareness of their weight and felt shamed by providers. Providers found weight loss interventions to be ineffective. Conclusion: Interventions in this population must address identified barriers: overweight/obesity as a normative value, lack of self-efficacy, cultural beliefs surrounding food, fear of HIV-associated weight loss and stigma, and provider perspectives on intervention futility

QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam Study

BACKGROUND: Increased QTc dispersion has been associated with an increased risk for ventricular arrhythmias and cardiac death in selected patient populations. We examined the association between computerized QTc-dispersion measurements and mortality in a prospective analysis of the p

Mammographic breast density in infertile and parous women

BACKGROUND: Mammographic breast density is a useful marker for breast cancer risk, as breast density is considered one of the strongest breast cancer risk factors. The study objective was to evaluate and compare mammographic breast density in infertile and parous women, as infertility may be associated with high breast density and cancer occurrence. METHODS: This study evaluated mammographic breast density using two different systems, BIRADS and Boyd. A selected patient population of 151 women with primary infertility (case group) was compared to 154 parous women who had at least one previous pregnancy (control group). Both groups were premenopausal women aged ≥ 35. RESULTS: Evaluation of mammographic features showed that 66.9% of case group patients and 53.9% of control group patients were classified BIRADS-3/BIRADS-4; p < 0.05. Adjusted Odds ratio for the case group in the categories BIRADS-3/BIRADS-4 was 1.78 (95% CI: 1.10-2.89). Using the Boyd classification system, 53.6% of case group patients and 31.8% of control group patients were classified E/F; p < 0.05. Adjusted Odds ratio for case group patients in Boyd categories E/F was 2.05 (95 % CI: 1.07-3.93). CONCLUSIONS: Both systems yielded a higher percentage of increased breast density in the case group. Boyd and BIRADS classification systems indicate to what extend breast cancer lesions may be missed on mammography due to masking by dense tissue. Therefore, patients with a high BIRADS or Boyd score should undergo further investigation

Integrated probability of coronary heart disease subject to the -308 tumor necrosis factor-alpha SNP: a Bayesian meta-analysis

We present a meta-analysis of independent studies on the potential implication in the occurrence of coronary heart disease (CHD) of the single-nucleotide polymorphism (SNP) at the -308 position of the tumor necrosis factor alpha (TNF-alpha) gene. We use Bayesian analysis to integrate independent data sets and to infer statistically robust measurements of correlation. Bayesian hypothesis testing indicates that there is no preference for the hypothesis that the -308 TNF-alpha SNP is related to the occurrence of CHD, in the Caucasian or in the Asian population, over the null hypothesis. As a measure of correlation, we use the probability of occurrence of CHD conditional on the presence of the SNP, derived as the posterior probability of the Bayesian meta-analysis. The conditional probability indicates that CHD is not more likely to occur when the SNP is present, which suggests that the -308 TNF-alpha SNP is not implicated in the occurrence of CHD.Comment: 21 pages, 7 figures, Published in PeerJ (2015

Pain in intensive care unit patients—A longitudinal study

Aim: To assess occurrence of pain during the first 6 days of intensive care unit (ICU) stay and evaluate associations between occurrence of pain and selected patient‐related variables. Design: A longitudinal study. Methods: Adult ICU patients from three units were included. Patients' pain was assessed with valid pain assessment tools every 8 hr during their first 6 days in ICU. Possible associations between occurrence of pain and selected patient‐related variables were modelled using multiple logistic regression. Results: When pain was assessed regularly with pain assessment tools, 10% of patients were in pain at rest and 27% were in pain during turning. The proportions of patients who were in pain were significantly higher for patients able to self‐report pain, compared with patients not able to self‐report (p < .001). Several predictors were associated with being in pain. It is important to be aware of these predictors in order to improve pain management.publishedVersio

Early closure of colostomy from abdominal trauma may be beneficial in otherwise healthy patients

A clinical decision report appraising Khalid MS, Moeen S, Khan AW, Arshad R, Khan AF. Same admission colostomy closure: a prospective, randomised study in selected patient groups. Surgeon. 2005;3(1):11-14. https://doi.org/10.1016/s1479-666x(05)80004-6 for a patient with loop transverse colostomy due to traum